Department of Oncology, Zhejiang University Jinhua Hospital, Zhejiang Province, China.
Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China; Institute of Gastroenterology, Zhejiang University, Zhejiang Province, China.
Clin Breast Cancer. 2018 Feb;18(1):e25-e39. doi: 10.1016/j.clbc.2017.05.015. Epub 2017 Jun 8.
There is no uniformly adopted cutoff value to define "young patients" with breast cancer. This study was designed to determine an optimal cutoff value, to investigate prognostic factors and to explore gene expression profiles of young female breast cancer.
The Surveillance, Epidemiology, and End Results database was examined to identify cases of female breast cancer diagnosed between 2000 and 2007. The optimal cutoff value for young age was determined using the X-tile program (Yale University, version 3.6.1). Age-specific gene expression profiles were explored using RNA sequence data from the Cancer Genome Atlas database.
The age of 40 years was determined as the optimal cutoff value. Among 94,087 patients, 12,755 were aged 40 years or younger (younger group), and 81,332 were older (older group). The 5- and 10-year cancer-specific survival rates in younger and older groups were 88.74% and 80.65%, respectively, and 93.22% and 88.43%, respectively (P < .001). Univariate and multivariate analyses indicated younger patients had worse prognosis. Subgroup analysis according to estrogen receptor (ER) showed the risk for cancer-specific death of ER-positive (ER) younger patients increased by approximately 2 times (hazard ratio, 1.96) compared with ER older patients. We failed to find any age-related gene in 509 patients after adjusting according to subtype (50-gene prediction analysis of a microarray) and histological type.
The age of 40 years is a reasonable cutoff value for defining "young." Young patients with breast cancer, especially those in the ER subgroup, have worse prognosis. However, we found that young breast cancer is not a unique biological entity, and therefore, a lack of new potential targets.
目前尚无统一定义乳腺癌“年轻患者”的标准界值。本研究旨在确定最佳界值，探讨预后相关因素，并探索年轻女性乳腺癌的基因表达谱。
本研究利用监测、流行病学和最终结果数据库，筛选 2000 年至 2007 年间诊断为女性乳腺癌的患者。采用 X-tile 程序（耶鲁大学，版本 3.6.1）确定年轻年龄的最佳界值。利用癌症基因组图谱数据库的 RNA 序列数据探索年龄特异性的基因表达谱。
将 40 岁作为最佳界值。在 94087 例患者中，年龄 40 岁或以下者为 12755 例（年轻组），年龄 40 岁以上者为 81332 例（年长组）。年轻组和年长组的 5 年和 10 年癌症特异性生存率分别为 88.74%和 80.65%，93.22%和 88.43%（P<0.001）。单因素和多因素分析均表明年轻患者的预后较差。根据雌激素受体（ER）进行亚组分析显示，ER 阳性（ER）年轻患者的癌症特异性死亡风险较 ER 年长患者增加约 2 倍（危险比，1.96）。根据亚型（微阵列的 50 个基因预测分析）和组织学类型进行调整后，我们在 509 例患者中未发现任何与年龄相关的基因。
40 岁是定义“年轻”的合理界值。年轻乳腺癌患者，尤其是 ER 亚组患者，预后较差。然而，我们发现年轻乳腺癌并非独特的生物学实体，因此缺乏新的潜在靶点。
