Young Women's Breast Cancer Program, University of Colorado Cancer Center, Aurora, CO, USA; Division of Medical Oncology, University of Colorado Denver, Aurora, CO, USA.
Department of Biostatistics and Bioinformatics, University of Colorado Denver, Aurora, CO, USA.
Eur J Cancer. 2022 Jun;168:119-127. doi: 10.1016/j.ejca.2022.03.014. Epub 2022 May 4.
Women diagnosed with breast cancer prior to age 45 years (<45y) and within the first 5 years postpartum (postpartum breast cancer, PPBC) have the greatest risk for distal metastatic recurrence.
Pooling data from the Colorado Young Women Breast Cancer cohort and the Breast Cancer Health Disparities Study (N = 2519 cases), we examined the association of parity, age, and clinical factors with overall survival (OS) of breast cancer over 15 years of follow-up.
Women with PPBC diagnosed at <45y had the lowest OS (p < 0.0001), while OS of nulliparous cases diagnosed at <45y did not differ from OS of cases diagnosed at 45-65y regardless of parity status. After adjustment for study site, race/ethnicity, clinical stage, year of diagnosis and stratification for oestrogen receptor status, PPBC remained an independent factor associated with poor OS. Among cases diagnosed at <45y, nulliparous cases had 1.6 times better OS (hazard ratio (HR) = 0.61, 95%CI 0.42-0.87) compared to those with PPBC, with a more pronounced survival difference among stage I breast cancers (HR = 0.30, 95%CI 0.11-0.79). Among very young women diagnosed at age ≤35y, nulliparous cases had 2.3 times better OS (HR = 0.44, 95%CI 0.23-0.84) compared to PPBC.
Our results suggest that postpartum status is the main driver of poor prognosis in young women with breast cancer, with the strongest association in patients diagnosed at age ≤35y and in those with stage I disease.
45 岁以下（<45y）和产后 5 年内（产后乳腺癌，PPBC）被诊断患有乳腺癌的女性发生远端转移性复发的风险最高。
我们汇集了科罗拉多州年轻女性乳腺癌队列和乳腺癌健康差异研究（N=2519 例病例）的数据，研究了生育次数、年龄和临床因素与 15 年以上随访的乳腺癌总体生存率（OS）之间的关系。
<45y 被诊断为 PPBC 的女性 OS 最低（p<0.0001），而 <45y 被诊断为未生育的病例的 OS 与 45-65y 被诊断为病例的 OS 没有差异，无论其生育状态如何。在校正研究地点、种族/族裔、临床分期、诊断年份和雌激素受体状态分层后，PPBC 仍然是与不良 OS 相关的独立因素。在<45y 被诊断为病例的女性中，未生育的病例 OS 更好，风险比（HR）为 0.61（95%CI 0.42-0.87），与 I 期乳腺癌的生存差异更为明显（HR 为 0.30，95%CI 0.11-0.79）。在≤35y 被诊断为非常年轻的女性中，未生育的病例 OS 更好，风险比（HR）为 0.44（95%CI 0.23-0.84）。
我们的研究结果表明，产后状态是年轻乳腺癌患者预后不良的主要驱动因素，在≤35y 被诊断为病例和 I 期疾病的患者中关联最强。
