Yoon Tae In, Hwang Ui-Kang, Kim Eui Tae, Lee SaeByul, Sohn Guiyun, Ko Beom Seok, Lee Jong Won, Son Byung Ho, Kim Seonok, Ahn Sei Hyun, Kim Hee Jeong
Department of Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Trauma Surgery, Andong Medical Group Hospital, Andong, Republic of Korea.
Breast Cancer Res Treat. 2017 Sep;165(2):311-320. doi: 10.1007/s10549-017-4331-4. Epub 2017 Jun 10.
We investigated the oncologic outcomes by intrinsic subtype and age in young breast cancer patients and whether survival differences were related to treatment changes over time.
A retrospective analysis was performed on 9633 invasive breast cancer patients treated at Asan Medical Center from January 1989 to December 2008. We also enrolled a matched cohort adjusting for tumor size, lymph node metastasis, subtypes, and tumor grade. Patients aged <35 years were included in the younger group (n = 602) and those aged ≥35 years were included in the older group (n = 3009).
The younger patients showed a significantly higher T stage, a more frequent axillary node presentation, higher histologic grade, and higher incidence of triple-negative subtype tumors than older patients and also received more chemotherapy and were less likely to undergo hormone therapy. The younger patients with hormone receptor (HR)-positive tumors showed significantly poorer disease-free survival (DFS), loco-regional recurrence-free survival, distant metastasis-free survival, and breast cancer-specific survival outcomes than older patients. Younger patients with HR-positive and human epidermal growth factor receptor 2 (HER2)-negative tumor subtypes had a significantly improved DFS over time (p = 0.032). Within the HR-positive/Her2-negative subtype, more women received gonadotropin-releasing hormone agonist and tamoxifen treatment from 2003 to 2008 compared with 1989 to 2002 (p = 0.001 and p = 0.075, respectively).
HR-positive young breast cancer patients have a poorer survival compared with older patients, even with more frequent chemotherapy, but more recent use of tamoxifen and ovarian suppression might improve this outcome in these patients.
我们研究了年轻乳腺癌患者按内在亚型和年龄划分的肿瘤学结局，以及生存差异是否与随时间变化的治疗改变有关。
对1989年1月至2008年12月在峨山医学中心接受治疗的9633例浸润性乳腺癌患者进行回顾性分析。我们还纳入了一个根据肿瘤大小、淋巴结转移、亚型和肿瘤分级进行匹配的队列。年龄<35岁的患者纳入较年轻组（n = 602），年龄≥35岁的患者纳入较年长组（n = 3009）。
较年轻患者与较年长患者相比，T分期显著更高，腋窝淋巴结受累更常见，组织学分级更高，三阴性亚型肿瘤的发生率更高，且接受化疗更多，接受激素治疗的可能性更小。激素受体（HR）阳性肿瘤的较年轻患者与较年长患者相比，无病生存期（DFS）、局部区域无复发生存期、远处转移无复发生存期和乳腺癌特异性生存结局显著更差。HR阳性且人表皮生长因子受体2（HER2）阴性肿瘤亚型的较年轻患者随时间推移DFS有显著改善（p = 0.032）。在HR阳性/HER2阴性亚型中，与1989年至2002年相比，2003年至2008年有更多女性接受促性腺激素释放激素激动剂和他莫昔芬治疗（分别为p = 0.001和p = 0.075）。
HR阳性的年轻乳腺癌患者与年长患者相比，即使化疗更频繁，生存情况仍较差，但近期使用他莫昔芬和卵巢抑制可能会改善这些患者的这一结局。
