Karihtala Peeter, Jääskeläinen Anniina, Roininen Nelli, Jukkola Arja
Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre, University of Helsinki, Helsinki, Finland
Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
BMJ Open. 2021 Jan 31;11(1):e041706. doi: 10.1136/bmjopen-2020-041706.
Being either young or old at the time of breast cancer diagnosis has been suggested as an indicator of a poor prognosis. We studied the effect of age at breast cancer onset in relation to survival, focusing in particular on biological subtypes and reproductive anamnesis.
DESIGN, SETTING AND PARTICIPANTS: Patients with early breast cancer (n=594) treated in a Finnish University Hospital during 2003-2013 were prospectively collected and followed in median 102 months.
Patients with luminal A-like breast cancer were older than the patients with luminal B-like (HER2-positive) (p=0.045) or patients with the HER2-positive (non-luminal) subtype (p=0.029). Patients ≥70 years received substantially less adjuvant chemotherapy (p=1.5×10) and radiotherapy (p=5.9×10) than younger women. Nevertheless, the estimated 10-year breast cancer-specific rates of survival were 84.2%, 92.9% and 87.0% in age groups <41 years, 41-69 years and ≥70 years, respectively, with no statistical difference (p=0.115). Survival rates were also comparable between the three age groups when assessed separately in different biological subtypes, and for patients with metastatic breast cancer there was similarly no difference between the age groups. Later menarche (p=5.7×10) and high parity (p=0.000078) correlated with increased age at breast cancer diagnosis, but, according to the patients' oestrogen receptor (ER) status, only among ER-positive patients.
Despite the suggested undertreatment of older patients, we report excellent long-term outcomes in all age groups in this prospective cohort. Later endogenous endocrine exposure may cause delay in breast cancer onset, but the exact biology behind this phenomenon is so far unclear.
乳腺癌诊断时年龄过小或过大被认为是预后不良的一个指标。我们研究了乳腺癌发病年龄对生存的影响，特别关注生物学亚型和生育史。
设计、地点和参与者：前瞻性收集了2003年至2013年期间在芬兰一家大学医院接受治疗的早期乳腺癌患者（n = 594），并对其进行了中位时间为102个月的随访。
管腔A型乳腺癌患者比管腔B型（HER2阳性）患者（p = 0.045）或HER2阳性（非管腔型）亚型患者（p = 0.029）年龄更大。70岁及以上的患者接受辅助化疗（p = 1.5×10）和放疗（p = 5.9×10）的比例明显低于年轻女性。然而，年龄<41岁、41 - 69岁和≥70岁年龄组的估计10年乳腺癌特异性生存率分别为84.2%、92.9%和87.0%，无统计学差异（p = 0.115）。在不同生物学亚型中分别评估时，三个年龄组的生存率也具有可比性，对于转移性乳腺癌患者，各年龄组之间同样没有差异。月经初潮较晚（p = 5.7×10）和高生育次数（p = 0.000078）与乳腺癌诊断时年龄增加相关，但根据患者的雌激素受体（ER）状态，仅在ER阳性患者中如此。
尽管有观点认为老年患者治疗不足，但我们在这个前瞻性队列中报告了所有年龄组都有出色的长期预后。内源性内分泌暴露较晚可能导致乳腺癌发病延迟，但目前尚不清楚这一现象背后的确切生物学机制。
