Richards Morgan K, Goldin Adam B, Beierle Elizabeth A, Doski John J, Goldfarb Melanie, Langer Monica, Nuchtern Jed G, Vasudevan Sanjeev, Gow Kenneth W, Javid Sara H
Department of Surgery, University of Washington, Seattle, WA, 98195, USA.
Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, 98195, USA.
Ann Surg Oncol. 2017 Jun;24(6):1482-1491. doi: 10.1245/s10434-016-5747-5. Epub 2017 Jan 5.
Pediatric breast malignancies are rare, and descriptions in the literature are limited. The purpose of our study was to compare pediatric and adult breast malignancy.
We performed a retrospective cohort study using the National Cancer Data Base comparing patients ≤21 years to those >21 years at diagnosis (1998-2012). Generalized linear models estimated differences in demographic, tumor, and treatment characteristics. Cox regression was used to compare overall survival.
Of 1,999,181 cases of invasive breast malignancies, 477 (0.02%) occurred in patients ≤21 years. Ninety-nine percent of adult patients had invasive carcinoma compared with 64.8% of pediatric patients with the remaining patients having sarcoma, malignant phyllodes, or malignancy not otherwise specified (p < 0.001). Pediatric patients were twice as likely to have an undifferentiated malignancy [relative risk (RR) 2.19; 95% confidence interval (CI) 1.72-3.79]. Half of adults presented with Stage I disease compared with only 22.7% of pediatric patients (p < 0.001). Pediatric patients were 40% more likely to have positive axillary nodes (RR 1.42; 95% CI 1.10-1.84). Among patients with invasive carcinoma, pediatric patients were more than four times as likely to receive a bilateral than a unilateral mastectomy compared with adults (RR 4.56; 95% CI 3.19-6.53). There was no difference in overall survival between children and adults.
Pediatric breast malignancies are more advanced at presentation, and there is variability in treatment practices. Adult and pediatric patients with invasive carcinoma have similar overall survival.
儿童乳腺恶性肿瘤较为罕见，文献中的描述有限。我们研究的目的是比较儿童和成人乳腺恶性肿瘤。
我们利用国家癌症数据库进行了一项回顾性队列研究，比较诊断时年龄≤21岁的患者与年龄>21岁的患者（1998 - 2012年）。广义线性模型估计了人口统计学、肿瘤和治疗特征方面的差异。采用Cox回归比较总生存率。
在1,999,181例浸润性乳腺恶性肿瘤病例中，477例（0.02%）发生在年龄≤21岁的患者中。99%的成年患者患有浸润性癌，而儿童患者中这一比例为64.8%，其余患者患有肉瘤、恶性叶状肿瘤或未另行指定的恶性肿瘤（p < 0.001）。儿童患者发生未分化恶性肿瘤的可能性是成人的两倍[相对风险（RR）2.19；95%置信区间（CI）1.72 - 3.79]。一半的成年患者表现为I期疾病，而儿童患者中这一比例仅为22.7%（p < 0.001）。儿童患者腋窝淋巴结阳性的可能性比成人高40%（RR 1.42；95% CI 1.10 - 1.84）。在浸润性癌患者中，与成人相比，儿童患者接受双侧乳房切除术的可能性是单侧乳房切除术的四倍多（RR 4.56；95% CI 3.19 - 6.53）。儿童和成人的总生存率没有差异。
儿童乳腺恶性肿瘤在就诊时病情更为严重，治疗方法存在差异。浸润性癌的成年和儿童患者总生存率相似。
