Billena Cole, Wilgucki Molly, Flynn Jessica, Modlin Leslie, Tadros Audree, Razavi Pedram, Braunstein Lior Z, Gillespie Erin, Cahlon Oren, McCormick Beryl, Zhang Zhigang, Morrow Monica, Powell Simon, Khan Atif J
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, New York.
Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):1007-1018. doi: 10.1016/j.ijrobp.2020.10.022. Epub 2020 Oct 24.
Breast cancer diagnosis at a very young age has been independently correlated with worse outcomes. Appropriately intensifying treatment in these patients is warranted, even as we acknowledge the risks of potentially mutagenic adjuvant therapies. We examined local control, distant control, overall survival, and secondary malignancy rates by age cohort and by initial surgical strategy.
Female patients less than or equal to 35 years of age diagnosed with invasive breast cancer from January 1, 1990, to December 31, 2010, were identified. Control groups of those aged 36 to 50 years (n = 6246) and 51 to 70 years (n = 7294) were delineated from an institutional registry. Clinicopathologic and follow-up information was collected. Chi-squared test was used to compare frequencies of categorical variables. Survival endpoints were evaluated using Kaplan-Meier methodology.
A total of 529 patients ≤35 years of age met criteria for analysis. The median age of diagnosis was 32 years (range 20-35). Median follow-up was 10.3 years. On multivariable analysis, factors associated with overall survival (OS) were tumor size (hazard ratio [HR] 1.14, P = .02), presence of lymphovascular invasion (HR 2.2, P <.001), estrogen receptor positivity (HR 0.64, P = .015), receipt of adjuvant chemotherapy (HR 0.52, P = .035), and black race (HR 2.87, P <.001). The ultra-young were more likely to experience local failure compared with the aged 36 to 50 group (HR 2.2, 95% CI 1.8-2.6, P < .001) and aged 51 to 70 group (HR 3.1, 95% CI 2.45 - 3.9, P <.001). The cumulative incidence of secondary malignancies at 5 and 10 years was 2.2% and 4.4%, respectively. Receipt of radiation was not significantly associated with secondary malignancies or contralateral breast cancer.
Survival and recurrence outcomes in breast cancer patients ≤35 years are worse compared with those aged 36 to 50 or 51 to 70 years. Based on our data, breast conservation therapy is appropriate for these patients, and the concern for second malignancies should not impinge on the known indications for postoperative radiation therapy.
极年轻女性乳腺癌的诊断已被证实与较差的预后相关。即便我们承认潜在致突变辅助治疗存在风险，但对这些患者进行适当强化治疗仍有必要。我们按年龄队列和初始手术策略研究了局部控制、远处控制、总生存率和继发性恶性肿瘤发生率。
确定了1990年1月1日至2010年12月31日期间诊断为浸润性乳腺癌的年龄小于或等于35岁的女性患者。从机构登记处划定了年龄在36至50岁（n = 6246）和51至70岁（n = 7294）的对照组。收集了临床病理和随访信息。采用卡方检验比较分类变量的频率。使用Kaplan-Meier方法评估生存终点。
共有529名年龄≤35岁的患者符合分析标准。诊断时的中位年龄为32岁（范围20 - 35岁）。中位随访时间为10.3年。多变量分析显示，与总生存（OS）相关的因素有肿瘤大小（风险比[HR] 1.14，P = 0.02）、存在淋巴管浸润（HR 2.2，P < 0.001）、雌激素受体阳性（HR 0.64，P = 0.015）、接受辅助化疗（HR 0.52，P = 0.035）和黑人种族（HR 2.87，P < 0.001）。与36至50岁组（HR 2.2，95%可信区间1.8 - 2.6，P < 0.001）和51至70岁组（HR 3.1，95%可信区间2.45 - 3.9，P < 0.001）相比，极年轻患者更易发生局部失败。5年和10年时继发性恶性肿瘤的累积发生率分别为2.2%和4.4%。接受放疗与继发性恶性肿瘤或对侧乳腺癌无显著关联。
与36至50岁或51至70岁的乳腺癌患者相比，年龄≤35岁的患者生存和复发结局较差。基于我们的数据，保乳治疗适用于这些患者，对继发性恶性肿瘤的担忧不应影响术后放疗的已知适应证。
