青少年和青年乳腺癌患者的疾病和治疗比四十多岁的患者更具侵袭性。

Adolescents and Young Adults with Breast Cancer have More Aggressive Disease and Treatment Than Patients in Their Forties.

机构信息

Department of Surgery, Mayo Clinic, Rochester, MN, USA.

The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.

出版信息

Ann Surg Oncol. 2019 Nov;26(12):3920-3930. doi: 10.1245/s10434-019-07653-9. Epub 2019 Aug 2.

DOI:10.1245/s10434-019-07653-9

PMID:31376035

Abstract

BACKGROUND

Adolescents and young adults (AYAs; age < 40 years) account for less than 2% of breast cancer patients. Therefore, little is known about the tumor characteristics and care provided to AYA patients. This study sought to describe demographic, tumor, and treatment variables among AYA patients.

METHODS

The study identified patients ages 15 to 49 years with breast cancer between 2010 and 2015 from the National Cancer Database. Patient and tumor factors were compared using Chi-square tests. Multivariable logistic regression was used to model the effect of age group on treatment while adjusting for confounding variables.

RESULTS

The study identified 46,265 AYA patients with stages 0 to 3 breast cancer and compared them with 169,423 breast cancer patients ages 40 to 49 years. A greater proportion of the AYA patients presented with clinical stage 2 or 3 disease than the adult patients 40 to 49 years old (stage 2 disease: 44.3% vs 29.9%, respectively; stage 3 disease: 14.0% vs 7.7%, respectively; both p < 0.001). A greater proportion of the AYA patients had triple-negative breast cancer (TNBC) or human epidermal growth factor receptor 2-positive (HER2+) cancer than the adult patients (TNBC: 21.2% vs 13.8%, respectively; HER2+: 26.0% vs 18.6%, respectively; both p < 0.001). Among the AYA patients, the very young (ages 15-29 years) had more advanced disease and TNBC or HER2+ disease than the older youth (ages 30 to 39 years). The multivariable analysis showed that the AYA patients were more likely to undergo mastectomy (odds ratio [OR] 2.1) and receive chemotherapy (OR 1.9) than patients in their forties (both p < 0.001).

CONCLUSION

A greater proportion of the AYA breast cancer patients had more advanced disease and TNBC and HER2+ disease. The AYA patients had higher rates of mastectomy and use of chemotherapy than the adult breast cancer patients, reflecting that more aggressive therapy is recommended or chosen for women in this age group.

摘要

背景

青少年和年轻人（AYA；年龄<40 岁）占乳腺癌患者的比例不到 2%。因此，对于 AYA 患者的肿瘤特征和护理知之甚少。本研究旨在描述 AYA 患者的人口统计学、肿瘤和治疗变量。

方法

本研究从国家癌症数据库中确定了 2010 年至 2015 年间年龄在 15 至 49 岁之间患有乳腺癌的患者。使用卡方检验比较患者和肿瘤因素。多变量逻辑回归用于在调整混杂变量的同时，对年龄组对治疗的影响进行建模。

结果

本研究确定了 46265 名患有 0 至 3 期乳腺癌的 AYA 患者，并将他们与 169423 名年龄在 40 至 49 岁的乳腺癌患者进行了比较。与 40 至 49 岁的成年患者相比，更多的 AYA 患者表现出临床 2 期或 3 期疾病（分别为 2 期疾病：44.3%比 29.9%；3 期疾病：14.0%比 7.7%；均 p<0.001）。与成年患者相比，更多的 AYA 患者患有三阴性乳腺癌（TNBC）或人表皮生长因子受体 2 阳性（HER2+）乳腺癌（TNBC：21.2%比 13.8%；HER2+：26.0%比 18.6%；均 p<0.001）。在 AYA 患者中，年龄较小的（15-29 岁）比年龄较大的青年（30-39 岁）患者疾病更晚期，且更易患有 TNBC 或 HER2+疾病。多变量分析显示，与 40 多岁的患者相比，AYA 患者更有可能接受乳房切除术（优势比 [OR] 2.1）和接受化疗（OR 1.9）（均 p<0.001）。