Division of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Breast Cancer Res Treat. 2013 Apr;138(3):941-50. doi: 10.1007/s10549-013-2507-0. Epub 2013 Apr 4.
Although previous studies have reported that onset at young age is associated with poor prognosis in breast cancer, the correlation between reproductive factors, breast cancer characteristics, and prognosis remains unclear. Five hundred and twenty-six premenopausal young women diagnosed with primary invasive breast cancer between January 2000 and December 2007 were included in this study. Patients were classified into four groups according to their reproductive history: women who gave birth within the previous 2 years (group A), women who gave birth between 3 and 5 years previously (group B), women who gave birth more than 5 years previously (group C), and nulliparous women (group N). The correlation between the time since last childbirth to diagnosis, histopathological tumor features, and breast cancer prognosis was evaluated. Breast cancer patients who had given birth more recently had more advanced stage tumors; larger sized tumors; a higher rate of axillary lymph node metastases; a higher histological tumor grade; and increased progesterone receptor (PgR)-, HER2+, and triple negative tumors than patients who had given birth less recently or not at all. Group A patients had significantly shorter survival times than patients in both groups C and N (log rank test; p < 0.001). After adjusting for tumor characteristics, the hazard ratio for death in group A was 2.19 compared with group N (p = 0.036), and the adjusted hazard ratio restricted to patients in group A with hormone-receptor-positive, and HER2- tumors was 3.07 (p = 0.011). Young breast cancer patients who had given birth more recently had tumors with more aggressive features and worse prognoses compared with patients who had given birth less recently or were nulliparous.
虽然先前的研究报告称，乳腺癌发病年龄较轻与预后不良相关，但生殖因素、乳腺癌特征与预后之间的相关性仍不清楚。本研究纳入了 526 例 2000 年 1 月至 2007 年 12 月期间诊断为原发性浸润性乳腺癌的绝经前年轻女性。根据生育史将患者分为四组：产后 2 年内（A 组）、产后 3-5 年（B 组）、产后 5 年以上（C 组）和未生育（N 组）。评估了从上次分娩到诊断的时间、组织病理学肿瘤特征与乳腺癌预后之间的相关性。最近分娩的乳腺癌患者肿瘤分期更晚、肿瘤体积更大、腋窝淋巴结转移率更高、组织学肿瘤分级更高、孕激素受体（PgR）阳性、HER2 阳性和三阴性肿瘤比例更高。与 C 组和 N 组相比，A 组患者的生存时间明显缩短（对数秩检验；p<0.001）。在校正肿瘤特征后，与 N 组相比，A 组患者死亡的风险比为 2.19（p=0.036），在 A 组中，将激素受体阳性且 HER2-肿瘤患者进行限制调整后，死亡风险比为 3.07（p=0.011）。与最近分娩或未生育的患者相比，最近分娩的年轻乳腺癌患者的肿瘤具有侵袭性更强的特征和更差的预后。
