School of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Ann Surg Oncol. 2022 Apr;29(4):2254-2260. doi: 10.1245/s10434-021-11102-x. Epub 2021 Nov 26.
Breast cancer in young women (ages 18-40 years) is rare, yet remains a leading cause of cancer-related death. Time to treatment (TTT) is an increasingly important factor in breast cancer outcomes, specifically time to systemic therapy. Our objective was to review patterns of care for young women presenting with invasive breast cancer and compare TTT for surgery first versus neoadjuvant chemotherapy (NAC).
A retrospective chart review of young women with non-metastatic, non-inflammatory invasive breast cancer between 2012 and 2018 at a single institution was completed. The primary outcome was time to first treatment (surgery or NAC).
One hundred forty-two young women were treated for invasive breast cancer during the study period. The majority of patients underwent surgery first (57.7%) compared with NAC (42.3%). Women who underwent NAC were more likely to have abnormal lymph nodes on imaging (p = 0.002) and clinical exam (p < 0.0001) and were also more likely to have larger tumor sizes (p < 0.05). The majority of triple negative patients underwent NAC first (88% [14/16]). Median TTT was significantly longer for surgery (27 [range 7-70] days) versus (20.5 [3-50] days) chemotherapy (p = 0.004). Median number of additional hospital visits prior to surgery was 4 (range 1-8) versus 5 (0-11) for NAC (p < 0.001).
Young women with breast cancer who undergo NAC have a shorter TTT and clinically similar median number of hospital visits compared with women undergoing surgery first. These results support the use of NAC in young women, when indicated, as additional workup and consultations prior to NAC do not delay care.
年轻女性（18-40 岁）的乳腺癌较为罕见，但仍是癌症相关死亡的主要原因。治疗时间（TTT）是乳腺癌预后的一个日益重要的因素，特别是系统治疗的时间。我们的目的是回顾年轻女性浸润性乳腺癌的治疗模式，并比较先手术与新辅助化疗（NAC）的 TTT。
对 2012 年至 2018 年期间在一家医疗机构就诊的年轻女性（年龄 18-40 岁）进行了非转移性、非炎症性浸润性乳腺癌的回顾性图表审查。主要结局是首次治疗（手术或 NAC）的时间。
在研究期间，有 142 名年轻女性接受了浸润性乳腺癌治疗。与 NAC（42.3%）相比，大多数患者先接受手术（57.7%）。接受 NAC 的女性更有可能在影像学（p=0.002）和临床检查（p<0.0001）上发现异常淋巴结，且肿瘤大小也更大（p<0.05）。大多数三阴性患者先接受 NAC（88%[14/16]）。手术组的 TTT 中位数明显长于化疗组（27[7-70]天）[20.5[3-50]天]（p=0.004）。手术前中位数增加的住院次数为 4 次（1-8 次），NAC 为 5 次（0-11 次）（p<0.001）。
对于需要接受 NAC 的年轻女性乳腺癌患者，与先手术的女性相比，TTT 更短，且临床相似的中位数住院次数也更少。这些结果支持在适当情况下对年轻女性使用 NAC，因为在接受 NAC 之前，额外的检查和会诊不会延迟治疗。
