Sun Zhi-Hong, Chen Chuang, Kuang Xin-Wen, Song Jun-Long, Sun Sheng-Rong, Wang Wei-Xing
Department of General Surgery.
Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
Medicine (Baltimore). 2021 May 7;100(18):e25880. doi: 10.1097/MD.0000000000025880.
Whether breast-conserving therapy (BCT) should be chosen as a local treatment for young women with early-stage breast cancer is controversial. This study compared the survival benefits of BCT or mastectomy in young women under 40 with early-stage breast cancer and further explored age-stratified outcomes. This study investigated whether there is a survival benefit when young women undergo BCT compared with mastectomy.The characteristics and prognosis of white women under 40 with stage I-II breast cancer from 1988 to 2016 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. These women were either treated with BCT or mastectomy. The log-rank test of the Kaplan-Meier survival curve and Cox proportional risk regression model were used to analyze the data and survival. The analysis was stratified by age (18-35 and 36-40 years).A total of 23,810 breast cancer patients were included, of whom 44.9% received BCT and 55.1% underwent mastectomy, with a median follow-up of 116 months. Patients undergoing mastectomy had a higher tumor burden and younger age. By the end of the 20th century, the proportion of BCT had grown from nearly 35% to approximately 60%, and then gradually fell to 35% into the 21st century. Compared with the mastectomy group, the BCT group had improved breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.917; 95% CI, 0.846-0.995, P = .037) and overall survival (OS) (HR 0.925; 95% CI, 0.859-0.997, P = .041). In stratified analysis according to the different ages, the survival benefit of BCT was more pronounced in the slightly older (36-40 years) group while there was no significant survival difference in the younger group (18-35 years).In young women with early-stage breast cancer, BCT showed survival benefits that were at least no worse than mastectomy, and these benefits were even better in the 36 to 40 years age group. Young age may not be a contraindication for BCT.
对于早期乳腺癌的年轻女性，保乳治疗（BCT）是否应作为局部治疗手段存在争议。本研究比较了40岁以下早期乳腺癌年轻女性接受BCT或乳房切除术的生存获益，并进一步探讨了按年龄分层的结果。本研究调查了年轻女性接受BCT与乳房切除术相比是否存在生存获益。使用监测、流行病学和最终结果（SEER）数据库分析了1988年至2016年期间年龄在40岁以下的I-II期乳腺癌白人女性的特征和预后。这些女性接受了BCT或乳房切除术治疗。采用Kaplan-Meier生存曲线的对数秩检验和Cox比例风险回归模型分析数据和生存率。分析按年龄分层（18 - 35岁和36 - 40岁）。
共纳入23810例乳腺癌患者，其中44.9%接受了BCT，55.1%接受了乳房切除术，中位随访时间为116个月。接受乳房切除术的患者肿瘤负荷更高且年龄更小。到20世纪末，BCT的比例从近35%增长到约60%，然后在21世纪逐渐降至35%。与乳房切除术组相比，BCT组的乳腺癌特异性生存率（BCSS）有所提高（风险比[HR] 0.917；95%可信区间，0.846 - 0.995，P = 0.037），总生存率（OS）也有所提高（HR 0.925；95%可信区间，0.859 - 0.997，P = 0.041）。在按不同年龄进行的分层分析中，BCT的生存获益在年龄稍大（36 - 40岁）组更为明显，而在年轻组（18 - 35岁）则无显著生存差异。
在早期乳腺癌的年轻女性中，BCT显示出至少不劣于乳房切除术的生存获益，且在36至40岁年龄组中这些获益甚至更好。年轻可能不是BCT的禁忌证。
