Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
Institut de Cancérologie de l'Ouest, site René Gauducheau, Site Hospitalier Nord, Boulevard Jacques Monod, 44800, Saint-Herblain, France.
Breast. 2020 Aug;52:50-57. doi: 10.1016/j.breast.2020.04.009. Epub 2020 Apr 23.
Young age is a poor prognostic factor in early stage breast cancer (BC) but its value is less established in metastatic BC (MBC). We evaluated the impact of age at MBC diagnosis on overall survival (OS) across three age groups (<40, 40 to 60 and > 60 years(y)).
ESME MBC database is a national cohort, collecting retrospective data from 18 participating French cancer centers between January 01, 2008 and December 31, 2014.
Among 14 403 women included, 1077 (7.5%), 6436 (44.7%) and 6890 (47.8%) pts were <40, 40-60 and > 60 y respectively. Pts <40 had significantly more aggressive presentations than other age groups: more frequent HER2+ (25.7 vs 15.3% in >60y) and triple negative subtypes (27.4 vs 14.6% in >60y), and more frequent visceral involvement (36.3 vs 29.8% in >60y). At a median follow-up of 48 months, median OS differed across age groups: 38.8, 38.4 and 35.6 months for pts <40, 40-60 and > 60y, respectively (p < 0.0001). Compared to pts <40y, older pts had a statistically significant higher risk of death (all causes of death included), although of limited clinical value (HR = 1.1, IC 95%:1.01-1.20). There was a significant trend for better OS in pts <40y with HER2+ and luminal diseases. A possible explanation is a greater use of anti-Her2 therapies as first-line treatments: 86.6, 81.9 and 74.9% for pts <40, 40-60 and > 60y, respectively (p < 0.0001).
Although young age seems associated with more aggressive presentations at diagnosis of MBC, it has no deleterious effect on OS in this large series.
在早期乳腺癌（BC）中，年轻是预后不良的因素，但在转移性乳腺癌（MBC）中其价值尚不确定。我们评估了 MBC 诊断时的年龄对三个年龄组（<40 岁、40-60 岁和>60 岁）的总生存（OS）的影响。
ESME MBC 数据库是一个全国性队列，收集了 2008 年 1 月 1 日至 2014 年 12 月 31 日期间 18 个参与的法国癌症中心的回顾性数据。
在纳入的 14403 名女性中，1077 名（7.5%）、6436 名（44.7%）和 6890 名（47.8%）pts 分别<40、40-60 和>60y。<40 岁的患者与其他年龄组相比，表现出更具侵袭性的特征：HER2+（25.7%比>60y 的 15.3%）和三阴性亚型（27.4%比>60y 的 14.6%）更为常见，且更常发生内脏转移（36.3%比>60y 的 29.8%）。在中位随访 48 个月时，不同年龄组的中位 OS 存在差异：<40 岁、40-60 岁和>60 岁的患者分别为 38.8、38.4 和 35.6 个月（p<0.0001）。与<40 岁的患者相比，年龄较大的患者死亡风险更高（包括所有死亡原因），尽管其临床价值有限（HR=1.1，95%CI：1.01-1.20）。在 HER2+和 luminal 疾病患者中，<40 岁的患者有更好的 OS 趋势。一个可能的解释是，随着一线治疗中抗 Her2 治疗的使用增多：<40 岁、40-60 岁和>60 岁的患者分别为 86.6%、81.9%和 74.9%（p<0.0001）。
尽管年轻似乎与 MBC 诊断时更具侵袭性的表现相关，但在本大数据系列中，它对 OS 没有不良影响。
