Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Republic of Korea.
Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University, Dongtan, Republic of Korea.
JAMA Netw Open. 2024 Nov 4;7(11):e2442663. doi: 10.1001/jamanetworkopen.2024.42663.
Young patients with breast cancer with estrogen receptor (ER)-positive, ERBB2-negative tumors have a poor prognosis. Understanding factors influencing late recurrence is crucial for improving management and outcomes.
To determine whether age is an independent factor associated with late distant recurrence (DR) in young patients with ER-positive, ERBB2-negative cancers without distant metastasis within 5 years from surgery.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective cohort study analyzed clinical records of patients with breast cancer who underwent surgery from January 2000 to December 2011 with at least 5 years of follow-up. The study was conducted at Samsung Medical Center, Gangnam Severance Hospital, and Seoul National University Hospital, including patients aged 45 years or younger with ER-positive, ERBB2-negative tumors, no DR within 5 years after surgery, no neoadjuvant chemotherapy, and at least 2 years of endocrine therapy. The data analysis period was from January 4, 2023, to March 21, 2024.
Age, grouped as 21 to 35 years, 36 to 40 years, and 41 to 45 years.
The primary outcome was the incidence of late DR at 5 to 10 years after surgery. Survival outcomes, including late distant metastasis-free survival (DMFS), were evaluated in different age groups.
Among 2772 patients included, 370 (13.3%) were aged 21 to 35 years, 885 (31.9%) were aged 36 to 40 years, and 1517 (54.7%) were aged 41 to 45 years. The median (range) follow-up was 10.8 (5.0-21.4) years. The youngest group had a poorer histologic grade (eg, histologic grade 3: 107 patients aged 21-35 years [28.9%]; 149 patients aged 36-40 years [16.8%]; 273 patients aged 41-45 years [18.0%]) and more frequent chemotherapy (307 patients aged 21-35 years [83.0%]; 697 patients aged 36-40 years [78.8%]; 1111 patients aged 41-45 years [73.2%]). The youngest patients had significantly worse rates of locoregional recurrence-free survival (patients aged 21-35 years, 90.1% [95% CI, 86.8%-93.3%]; patients aged 36-40 years, 94.6% [95% CI, 93.0%-96.2%]; patients aged 41-45 years, 97.7% [95% CI, 96.9%-98.5%]), disease-free survival (patients aged 21-35 years, 79.3% [95% CI, 75.0%-83.9%]; patients aged 36-40 years, 88.7% [95% CI, 86.5%-91.0%]; patients aged 41-45 years, 94.4% [95% CI, 93.2%-95.7%]), and late DMFS (patients aged 21-35 years, 89.3% [95% CI, 86.0%-92.9%]; patients aged 36-40 years: 94.2% [95% CI, 92.5%-95.9%]; patients aged 41-45 years: 97.2% [95% CI, 96.3%-98.1%]) but not overall survival (patients aged 21-35 years, 96.9% [95% CI, 95.0%-98.9%]; patients aged 36-40 years, 98.2% [95% CI, 97.2%-99.2%]; patients aged 41-45 years, 98.9% [95% CI, 98.3%-99.5%]). Multivariable analysis showed lower hazard for late DR in the older groups compared with the youngest group (age 36-40 years: hazard ratio, 0.53; 95% CI, 0.34-0.82; P = .001; age 41-45 years: hazard ratio, 0.30; 95% CI, 0.20-0.47; P < .001).
In this retrospective cohort study, age was an independent factor associated with late DR in young patients with ER-positive, ERBB2-negative breast cancer. Younger age was associated with worse locoregional recurrence-free survival, disease-free survival, and late DMFS, highlighting the importance of long-term monitoring and potential for personalized treatment approaches based on age, particularly for younger patients with ER-positive, ERBB2-negative breast cancer.
重要性：年轻的乳腺癌患者，激素受体（ER）阳性、ERBB2 阴性、肿瘤无远处转移，且术后 5 年内无远处复发（DR），预后较差。了解影响晚期复发的因素对于改善管理和预后至关重要。
目的：确定年龄是否是年轻的 ER 阳性、ERBB2 阴性癌症患者（术后 5 年内无远处转移、无新辅助化疗、至少接受 2 年内分泌治疗）的独立预后因素。
设计、地点和参与者：这是一项多中心回顾性队列研究，分析了 2000 年 1 月至 2011 年 12 月期间在三星医疗中心、江南Severance 医院和首尔国立大学医院接受手术且至少随访 5 年的患者的临床记录。纳入标准为年龄≤45 岁、ER 阳性、ERBB2 阴性、术后 5 年内无远处复发、无新辅助化疗、至少接受 2 年内分泌治疗。数据分析期为 2023 年 1 月 4 日至 2024 年 3 月 21 日。
暴露：年龄分为 21-35 岁、36-40 岁和 41-45 岁。
主要结局和措施：主要结局是术后 5-10 年的晚期 DR 发生率。在不同年龄组评估生存结局，包括晚期远处无转移生存（DMFS）。
结果：在 2772 例患者中，370 例（13.3%）年龄为 21-35 岁，885 例（31.9%）年龄为 36-40 岁，1517 例（54.7%）年龄为 41-45 岁。中位（范围）随访时间为 10.8（5.0-21.4）年。年龄最小的患者组织学分级较差（如组织学分级 3：21-35 岁患者 107 例[28.9%]；36-40 岁患者 149 例[16.8%]；41-45 岁患者 273 例[18.0%]），且更常接受化疗（21-35 岁患者 307 例[83.0%]；36-40 岁患者 697 例[78.8%]；41-45 岁患者 1111 例[73.2%]）。年龄最小的患者局部区域无复发生存率（21-35 岁患者 90.1%[95%CI，86.8%-93.3%]；36-40 岁患者 94.6%[95%CI，93.0%-96.2%]；41-45 岁患者 97.7%[95%CI，96.9%-98.5%]）、无病生存率（21-35 岁患者 79.3%[95%CI，75.0%-83.9%]；36-40 岁患者 88.7%[95%CI，86.5%-91.0%]；41-45 岁患者 94.4%[95%CI，93.2%-95.7%]）和晚期 DMFS（21-35 岁患者 89.3%[95%CI，86.0%-92.9%]；36-40 岁患者 94.2%[95%CI，92.5%-95.9%]；41-45 岁患者 97.2%[95%CI，96.3%-98.1%]）较差，但总生存（21-35 岁患者 96.9%[95%CI，95.0%-98.9%]；36-40 岁患者 98.2%[95%CI，97.2%-99.2%]；41-45 岁患者 98.9%[95%CI，98.3%-99.5%]）无差异。多变量分析显示，与年龄最小的患者相比，年龄较大的患者发生晚期 DR 的风险较低（年龄 36-40 岁：风险比 0.53；95%CI 0.34-0.82；P=0.001；年龄 41-45 岁：风险比 0.30；95%CI 0.20-0.47；P<0.001）。
结论和相关性：在这项回顾性队列研究中，年龄是年轻的 ER 阳性、ERBB2 阴性乳腺癌患者发生晚期 DR 的独立预后因素。年龄越小，局部区域无复发生存率、无病生存率和晚期 DMFS 越差，这强调了对年轻患者进行长期监测和潜在基于年龄的个体化治疗方法的重要性，尤其是对于 ER 阳性、ERBB2 阴性乳腺癌的年轻患者。
