年轻是黎巴嫩非转移性乳腺癌患者预后较差的独立预测因素：一项前瞻性队列分析。
Younger age is an independent predictor of worse prognosis among Lebanese nonmetastatic breast cancer patients: analysis of a prospective cohort.
作者信息
El Chediak Alissar, Alameddine Raafat S, Hakim Ayman, Hilal Lara, Abdel Massih Sarah, Hamieh Lana, Mukherji Deborah, Temraz Sally, Charafeddine Maya, Shamseddine Ali
机构信息
Division of Hematology/Oncology, Department of Internal Medicine.
Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
出版信息
Breast Cancer (Dove Med Press). 2017 Jun 10;9:407-414. doi: 10.2147/BCTT.S130273. eCollection 2017.
BACKGROUND
Several retrospective studies have reported that younger age at presentation is associated with a worse prognosis for nonmetastatic breast cancer patients. In this study, we prospectively assessed the association between different baseline characteristics (age, tumor characteristics, mode of treatment, etc) and outcomes among newly diagnosed nonmetastatic Lebanese breast cancer patients.
METHODS
We recruited a sample of 123 women newly diagnosed with nonmetastatic breast cancer presenting to American University of Beirut Medical Center. Immunohistochemical, molecular (vitamin D receptor, methylene tetrahydrofolate reductase polymorphisms), and genetic assays were performed. Patient characteristics were compared by age group (<40 and ≥40 years). A Cox regression analysis was performed to evaluate the variables affecting the disease-free survival (DFS). Outcome data were obtained, and DFS was estimated.
RESULTS
Among the 123 patients, 47 were 40 years of age or younger, and 76 were older than 40 years. Median follow-up duration was 58 months. Nine out of 47 patients <40 years (19.1%) experienced disease relapse in contrast to four out of 76 patients >40 years (5.2%). A wide immunohistochemical panel included Ki-67, cyclin B1, p53, platelet-derived growth factor receptor, and vascular endothelial growth factor receptor, and did not reveal any significant difference in these markers between the two age groups. Older patients had a larger percentage of Luminal A than younger patients. On multivariate analysis including age, stage, grade, and subtype, only age <40 and stage were significantly associated with shorter DFS with hazard ratios of 4 (=0.03, 95% confidence interval [CI]: 1.1-13.5) and 3 (=0.03, 95% CI: 0.8-14.9), respectively. The estimated 5-year DFS for patients >40 years was 90%, and for patients <40 years was 37%.
CONCLUSION
Being <40 years old was an independent risk factor for recurrence in this cohort of patients.
背景
多项回顾性研究报告称，初诊时年龄较小与非转移性乳腺癌患者的预后较差有关。在本研究中，我们前瞻性地评估了黎巴嫩新诊断的非转移性乳腺癌患者不同基线特征（年龄、肿瘤特征、治疗方式等）与预后之间的关联。
方法
我们招募了123名新诊断为非转移性乳腺癌并前往贝鲁特美国大学医学中心就诊的女性患者。进行了免疫组织化学、分子（维生素D受体、亚甲基四氢叶酸还原酶多态性）和基因检测。按年龄组（<40岁和≥40岁）比较患者特征。进行Cox回归分析以评估影响无病生存期（DFS）的变量。获取结局数据并估计DFS。
结果
123例患者中，47例年龄≤40岁，76例年龄>40岁。中位随访时间为58个月。47例<40岁的患者中有9例（19.1%）出现疾病复发，而76例>40岁的患者中有4例（5.2%）出现疾病复发。广泛的免疫组织化学检测项目包括Ki-67、细胞周期蛋白B1、p53、血小板衍生生长因子受体和血管内皮生长因子受体，未发现这两个年龄组在这些标志物上有任何显著差异。老年患者中Luminal A型的比例高于年轻患者。在包括年龄、分期、分级和亚型的多因素分析中，只有年龄<40岁和分期与较短的DFS显著相关，风险比分别为4（=0.03，95%置信区间[CI]：1.1-13.5）和3（=0.03，95%CI：0.8-14.9）。40岁以上患者的估计5年DFS为90%，40岁以下患者为37%。
结论
在该队列患者中，年龄<40岁是复发的独立危险因素。
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