Alieldin Nelly H, Abo-Elazm Omnia M, Bilal Dalia, Salem Salem Eid, Gouda Eman, Elmongy Magda, Ibrahim Amal S
Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
J Egypt Natl Canc Inst. 2014 Mar;26(1):23-30. doi: 10.1016/j.jnci.2013.08.005. Epub 2013 Oct 21.
Primary objective was to verify whether breast cancer patients aged less than 40 years at diagnosis have poorer prognosis than older patients. Secondary to assess prognostic factors influencing disease free survival.
941 women were diagnosed with non-metastatic breast cancer at NCI, Cairo in 2003. Epidemiologic, clinico-pathological characteristics, treatment modalities and disease free survival were compared among the two age groups. Prognostic factors were evaluated for association with disease-free survival.
One hundred-eighty-one patients (19.2%) were younger than 40 years and 760 (80.8%) were older. Older women presented with higher rates of comorbidities and younger women presented with more hormone non-responsive tumors. Young women presented with larger tumors pT4=13.8% compared to 8.6% in older women, yet not significant. Young women were treated with more conservative surgery, more adjuvant chemotherapy and radiotherapy while older women with more radical mastectomies and more hormonal treatment. Recurrence rates were significantly higher among young women 44.2% compared to 34.5% in older women. Five year disease free survival in young women was 38.9% ± 4.6% compared to 48.6% ± 2.5% with adjusted hazard ratio of 1.22 95% CI (0.91-1.64), p=0.19. Multivariate analyses identified positive axillary lymph nodes (pN2-pN3), larger tumor size (pT3-pT4), hypertension, lobular carcinoma type and lack of adjuvant systemic treatment as independent factors associated with poor DFS.
Young women were not found to have poorer prognosis, yet they presented with more ER negative tumors. Most of women presented with advanced stage and young women had higher recurrence rates.
主要目的是验证确诊时年龄小于40岁的乳腺癌患者预后是否比老年患者更差。次要目的是评估影响无病生存的预后因素。
2003年在开罗的美国国立癌症研究所，941名女性被诊断为非转移性乳腺癌。比较了两个年龄组的流行病学、临床病理特征、治疗方式和无病生存情况。评估预后因素与无病生存的相关性。
181名患者（19.2%）年龄小于40岁，760名（80.8%）年龄较大。老年女性合并症发生率较高，年轻女性激素不反应性肿瘤较多。年轻女性的肿瘤较大，pT4为13.8%，而老年女性为8.6%，但差异不显著。年轻女性接受更保守的手术、更多的辅助化疗和放疗，而老年女性接受更多的根治性乳房切除术和更多的激素治疗。年轻女性的复发率显著高于老年女性，分别为44.2%和34.5%。年轻女性的五年无病生存率为38.9%±4.6%，老年女性为48.6%±2.5%，调整后的风险比为1.22，95%可信区间（0.91-1.64），p=0.19。多因素分析确定腋窝淋巴结阳性（pN2-pN3）、肿瘤较大（pT3-pT4）、高血压、小叶癌类型和缺乏辅助全身治疗是与无病生存不良相关的独立因素。
未发现年轻女性预后更差，但她们的雌激素受体阴性肿瘤较多。大多数女性为晚期，年轻女性复发率较高。
