Li H, Zuo T T, Zeng H M, Zheng R S, Yang L, Li H C, Liu S, Yuan Y N, Wang N, Chen W Q
Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang 110042, China.
Zhonghua Zhong Liu Za Zhi. 2021 Jan 23;43(1):126-131. doi: 10.3760/cma.j.cn112152-20191212-00801.
To evaluate 5-years breast cancer-specific survival (CCS) by age, and the relationship of age at diagnosis and the risk of breast cancer mortality. Medical records of 3 470 resident patients diagnosed with primary, invasive female breast cancer between January 1, 2006 and December 31, 2010 in four hospitals in Beijing were reviewed and collected. All patients were followed up until December 31, 2018 to acquire survival outcome. Five-years breast CCS of the five subgroups was estimated by the life-table method. Cox proportional hazard regression models were used to estimate hazard ratios (s) and 95% confidence intervals (CIs) of different levels of age stratification and breast cancer mortality, and restricted cubic spline (RCS) model was used to detect the dose-response relationship. The median diagnosis age among 3 470 female breast cancer patients was 53.2 years. There were 1 289 patients in the age-group of 4554 years, with the highest proportion of 37.15%. However, only 126 patients occurred in the age-group of less than 35 years, with the lowest proportion of 3.63%. A total of 528 (15.22%) patients died of breast cancer during the study period. Overall 5-year CCS was 90.72% (95% 89.74%91.70%), 88.68% (95% 83.09%94.27%) and 87.05% (95% 84.27%89.82%) for all of the patients, aged less than 35 years and those aged 65 years and older. Compared with patients with diagnosis age of 4554 years, the multivariate-adjusted s for breast cancer mortality associated with patients in age-group of <35 years and those in the age-group of ≥65 years were 1.72 (95% 1.062.81) and 1.89 (95% 1.432.49), respectively. In addition, patients aged ≥65 years had significantly higher risk of breast cancer mortality in Luminal subtypes, with of 1.70 (95% 1.172.46) for Luminal A breast cancer and of 3.84 (95% 1.748.49) for Luminal B breast cancer. RCS analysis exhibited a non-linear ( "J-shaped" ) relationship between diagnosis age of female breast cancer and the risk of breast cancer mortality (nonlinear <0.000 1). In addition, patients aged ≥65 years had significantly higher risk of breast cancer mortality in Luminal subtypes, with of 1.70 (95% 1.172.46) for Luminal A breast cancer and of 3.84 (95% 1.74~8.49) for Luminal B breast cancer. RCS analysis exhibited a non-linear ( "J-shaped" ) relationship between diagnosis age of female breast cancer and the risk of breast cancer mortality (nonlinear <0.000 1). Age at diagnosis is an important prognostic factor for female breast cancer, with worse outcome for both young and old patients.
评估不同年龄组的5年乳腺癌特异性生存率（CCS），以及诊断时年龄与乳腺癌死亡风险之间的关系。回顾并收集了2006年1月1日至2010年12月31日期间在北京四家医院诊断为原发性浸润性女性乳腺癌的3470例住院患者的病历。对所有患者进行随访至2018年12月31日以获取生存结局。采用寿命表法估计五个亚组的5年乳腺癌CCS。使用Cox比例风险回归模型估计不同年龄分层水平与乳腺癌死亡率的风险比（HR）及95%置信区间（CI），并采用限制性立方样条（RCS）模型检测剂量反应关系。3470例女性乳腺癌患者的诊断年龄中位数为53.2岁。4554岁年龄组有1289例患者，比例最高，为37.15%。然而，年龄小于35岁的年龄组仅有126例患者，比例最低，为3.63%。在研究期间，共有528例（15.22%）患者死于乳腺癌。所有患者、年龄小于35岁的患者以及年龄65岁及以上的患者的5年总体CCS分别为90.72%（95% 89.74%91.70%）、88.68%（95% 83.09%94.27%）和87.05%（95% 84.27%89.82%）。与诊断年龄为4554岁的患者相比，年龄<35岁年龄组和≥65岁年龄组患者乳腺癌死亡的多因素调整后HR分别为1.72（95% 1.062.81）和1.89（95% 1.43~2.49）。此外，年龄≥65岁的患者在Luminal亚型中乳腺癌死亡风险显著更高，Luminal A型乳腺癌的HR为1.70（95%
1.172.46），Luminal B型乳腺癌的HR为3.84（95% 1.748.49）。RCS分析显示女性乳腺癌诊断年龄与乳腺癌死亡风险之间呈非线性（“J形”）关系（非线性P<0.000 1）。此外，年龄≥65岁的患者在Luminal亚型中乳腺癌死亡风险显著更高，Luminal A型乳腺癌的HR为1.70（95% 1.172.46），Luminal B型乳腺癌的HR为3.84（95% 1.748.49）。RCS分析显示女性乳腺癌诊断年龄与乳腺癌死亡风险之间呈非线性（“J形”）关系（非线性P<0.000 1）。诊断时年龄是女性乳腺癌的一个重要预后因素，年轻和老年患者的预后均较差。
