Zhang Xiao, Yang Jian, Cai Haoyang, Ye Yifeng
Department of Breast Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China,
Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan 610064, China,
Cancer Manag Res. 2018 Sep 27;10:4005-4018. doi: 10.2147/CMAR.S167363. eCollection 2018.
To compare the prognosis of young breast cancer patients with the older ones.
Utilizing the Surveillance, Epidemiology, and End Results database, we identified 150,588 female breast cancer patients diagnosed during 2003-2014, including 6,668 patients younger than 35 years and 143,920 patients aged between 35 and 60 years. Kaplan- Meier analysis was performed to compare the prognosis of these two groups. Univariate and multivariate Cox proportional hazard models were utilized to identify independent prognostic factors and calculate the HR and 95% CI. Subgroup analysis was performed stratified according to the lymph node status and estrogen receptor (ER) status.
The young patients presented with more aggressive clinicopathological characteristics, including larger tumor size (<0.001), more lymph node metastasis (<0.001), higher grade (grades III and IV, <0.001), more ER/progesterone receptor absence (<0.001), and more human epidermal growth factor receptor 2 overexpression (<0.001). The patients younger than 35 years presented with inferior breast cancer-specific survival (BCSS) and overall survival (OS) (log-rank, <0.001) in comparison with the older ones. In the multivariable Cox proportional hazard regression analysis, young age remained to be an independent adverse prognostic factor in operable breast cancer in terms of BCSS (HR, 1.200; 95% CI, 1.110-1.297; <0.001) and OS (HR, 1.111; 95% CI, 1.032-1.196; =0.005). In the subgroup analysis, young age remained a significant adverse prognostic factor in N0 (BCSS), N1, and ER-positive subgroups (<0.05).
Young age is an independent adverse prognostic factor in operable breast cancer. Young patients may receive more intensive treatment than older ones.
比较年轻乳腺癌患者与老年乳腺癌患者的预后情况。
利用监测、流行病学和最终结果数据库，我们确定了2003年至2014年期间诊断出的150588例女性乳腺癌患者，其中包括6668例年龄小于35岁的患者和143920例年龄在35至60岁之间的患者。采用Kaplan-Meier分析比较这两组患者的预后情况。使用单因素和多因素Cox比例风险模型来确定独立的预后因素，并计算风险比（HR）和95%置信区间（CI）。根据淋巴结状态和雌激素受体（ER）状态进行亚组分析。
年轻患者表现出更具侵袭性的临床病理特征，包括更大的肿瘤尺寸（<0.001）、更多的淋巴结转移（<0.001）、更高的分级（III级和IV级，<0.001）、更多的ER/孕激素受体缺失（<0.001）以及更多的人表皮生长因子受体2过表达（<0.001）。与老年患者相比，年龄小于35岁的患者表现出较差的乳腺癌特异性生存率（BCSS）和总生存率（OS）（对数秩检验，<0.001）。在多因素Cox比例风险回归分析中，就BCSS（HR，1.200；95%CI，1.110 - 1.297；<0.001）和OS（HR，1.111；95%CI，1.032 - 1.196；=0.005）而言，年轻仍然是可手术乳腺癌的独立不良预后因素。在亚组分析中，年轻在N0（BCSS）、N1和ER阳性亚组中仍然是显著的不良预后因素（<0.05）。
年轻是可手术乳腺癌的独立不良预后因素。年轻患者可能比老年患者接受更强化的治疗。
