Kurtz J M, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Spitalier J M
Department of Anatomic Pathology, Marseille Cancer Institute, France.
J Clin Oncol. 1990 Apr;8(4):591-8. doi: 10.1200/JCO.1990.8.4.591.
The influence of patient age on risk of recurrence in the breast was retrospectively studied in 496 stage I-II invasive ductal carcinomas treated by macroscopically complete primary tumor excision followed by radiotherapy. With a median follow-up of 71 months, local recurrence occurred in 13 of 62 (21%) patients younger than 40 years, compared with 48 of 434 (11%) older patients (P less than .025). Cox multivariate analysis of 18 parameters identified four that significantly determined risk: major lymphocytic stromal reaction (MCR), unsatisfactory resection margins, increasing histologic grade, and extensive intraductal cancer (DCIS) within the primary tumor. Compared with older patients, those younger than 40 years had tumors that more often exhibited MCR (36% v 20%, P less than .01), histologic grade 3 (42% v 28%, P less than .025), and very extensive DCIS (21% v 6%, P less than .001). The status of resection margins did not differ significantly between younger and older patients. Restriction of Cox analysis to patients younger than 40 indicated that risk was adequately described by MCR and percentage of DCIS, without consideration of grade or margins. For patients younger than 40, local failure occurred in four of five (80%) tumors with both MCR and more than 50% DCIS, in eight of 25 (32%) with either, and one of 32 (3.1%) with neither of these morphologic features. This study suggests that the higher local failure risk observed in patients younger than 40 years reflects the greater prevalence of certain morphologic characteristics in breast cancers in younger patients. Age itself does not appear to be an independent determinate of risk.
对496例接受了肉眼可见的原发性肿瘤完整切除并随后进行放疗的I-II期浸润性导管癌患者进行回顾性研究，以探讨患者年龄对乳腺癌复发风险的影响。中位随访时间为71个月，62例40岁以下患者中有13例（21%）发生局部复发，而434例年龄较大的患者中有48例（11%）发生局部复发（P<0.025）。对18个参数进行Cox多因素分析，确定了4个显著决定风险的因素：主要淋巴细胞间质反应（MCR）、切除边缘不理想、组织学分级增加以及原发性肿瘤内广泛的导管内癌（DCIS）。与年龄较大的患者相比，40岁以下的患者肿瘤更常表现出MCR（36%对20%，P<0.01）、组织学3级（42%对28%，P<0.025）和非常广泛的DCIS（21%对6%，P<0.001）。年轻患者和老年患者的切除边缘状态没有显著差异。将Cox分析限制在40岁以下的患者中表明，MCR和DCIS百分比能够充分描述风险，而无需考虑分级或边缘情况。对于40岁以下的患者，在同时具有MCR和超过50% DCIS的5个肿瘤中有4个（80%）发生局部失败，在具有其中任何一个特征的25个肿瘤中有8个（32%）发生局部失败，在不具有这两种形态学特征的32个肿瘤中有1个（3.1%）发生局部失败。本研究表明，40岁以下患者中观察到的较高局部失败风险反映了年轻患者乳腺癌中某些形态学特征的更高发生率。年龄本身似乎不是风险的独立决定因素。
