Alabdulkareem Hanan, Pinchinat Tiffany, Khan Sarah, Landers Alyssa, Christos Paul, Simmons Rache, Moo Tracy-Ann
New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
Breast J. 2018 Mar;24(2):148-153. doi: 10.1111/tbj.12853. Epub 2017 Jul 14.
Breast cancer is the leading cause of cancer death in women younger than 40 years. Triple-negative breast cancer (TNBC) and human epidermal growth factor receptor-2 (HER2) positive subtypes have a particularly poor prognosis in this age group. The purpose of this study was to compare rates of recurrence among breast cancer subtypes in young patients treated with modern adjuvant systemic therapy. A retrospective review of breast cancer patients managed at a major academic breast center between May 2000 and November 2014 was performed. We included 239 women with breast cancer who were diagnosed and treated at age ≤40 years. Clinical, pathological, therapeutic, and outcome data were recorded. Patients were classified into the following molecular subtypes: luminal A/B (estrogen receptor [ER] positive and/or progesterone receptor [PR] positive, and HER2 negative), luminal/HER2 (ER positive and/or PR positive, and HER2 positive), HER2- enriched (ER negative, PR negative, and HER2 positive) and TNBC (ER negative, PR negative, and HER2 negative). Descriptive statistics were used to characterize the study cohort. Kaplan-Meier survival analysis was performed to estimate recurrence-free survival (RFS). Median follow-up time was 29 months. Mean age was 34.5 years. Among all patients, 193 (80.8%) were diagnosed with Invasive breast cancer and 46 (19.2%) with ductal carcinoma in situ with or without microinvasion. Subclassification into molecular subtypes was complete for 199 patients among which, 50.7% were classified as luminal A/B, 21.1% luminal/HER2, 12.1% HER2-enriched and 16.1% TNBC. Of the 199 patients, 25.1% received neo-adjuvant chemotherapy and 59.2% received adjuvant chemotherapy. Among HER2-positive patients, 81.3% received HER2 directed therapy. Twenty-eight patients (11.7%) had recurrences (13 loco-regional, seven distant, and eight both). At 3 years, the HER2 subtype had the highest RFS 100%, compared to 91.1% in luminal A/B, 85.6% in luminal/HER2 and 81.9% in TNBC. In comparing outcomes among subtypes, the HER2 positive subtype was associated with improved RFS, likely reflecting the impact of HER2 directed therapy. Those young patients with triple-negative subtype continued to have the poorest outcomes.
乳腺癌是40岁以下女性癌症死亡的主要原因。三阴性乳腺癌（TNBC）和人表皮生长因子受体2（HER2）阳性亚型在该年龄组中的预后尤其差。本研究的目的是比较接受现代辅助全身治疗的年轻乳腺癌患者中各亚型的复发率。对2000年5月至2014年11月在一家大型学术性乳腺中心接受治疗的乳腺癌患者进行了回顾性研究。我们纳入了239例年龄≤40岁且被诊断并接受治疗的乳腺癌女性患者。记录了临床、病理、治疗及预后数据。患者被分为以下分子亚型：腔面A/B型（雌激素受体[ER]阳性和/或孕激素受体[PR]阳性，且HER2阴性）、腔面/HER2型（ER阳性和/或PR阳性，且HER2阳性）、HER2富集型（ER阴性、PR阴性且HER2阳性）和TNBC型（ER阴性、PR阴性且HER2阴性）。采用描述性统计来描述研究队列的特征。进行Kaplan-Meier生存分析以估计无复发生存期（RFS）。中位随访时间为29个月。平均年龄为34.5岁。在所有患者中，193例（80.8%）被诊断为浸润性乳腺癌，46例（19.2%）为原位导管癌伴或不伴微浸润。199例患者完成了分子亚型分类，其中50.7%被分类为腔面A/B型，21.1%为腔面/HER2型，12.1%为HER2富集型，16.1%为TNBC型。在这199例患者中，25.1%接受了新辅助化疗，59.2%接受了辅助化疗。在HER2阳性患者中，81.3%接受了HER2靶向治疗。28例患者（11.7%）出现复发（13例为局部区域复发，7例为远处复发，8例为两者均有）。3年时，HER2亚型的RFS最高，为100%，相比之下，腔面A/B型为91.1%，腔面/HER2型为85.6%，TNBC型为81.9%。在比较各亚型的预后时，HER2阳性亚型与改善的RFS相关，这可能反映了HER2靶向治疗的影响。那些三阴性亚型的年轻患者预后仍然最差。
