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Abstract：
In young women, a breast cancer diagnosis after childbirth increases the risk for metastasis and death. Studies in rodents suggest that post-weaning mammary gland involution contributes to the poor prognosis of postpartum breast cancers. However, this association has not been investigated in humans, mainly because of missing information on the patient\'s lactation status at diagnosis.
Clinicopathological data of 1180 young women with primary invasive breast cancer, diagnosed within 2 years postpartum (PP-BC), during pregnancy (Pr-BC), or nulliparous (NP-BC), were collected. For PP-BC patients, breastfeeding history was retrieved to differentiate breast cancers identified during lactation (PP-BCDL) from those diagnosed post-weaning (PP-BCPW). Differences in prognostic parameters, first site of distant metastasis, and risks for metastasis and death were determined between patient groups.
Cox proportional hazard models pointed to a twofold increased the risk of metastasis and death in PP-BCPW patients compared with PP-BCDL (hazard ratio [HR] 2.1 [PDRS = 0.021] and 2.9 [POS = 0.004]), Pr-BC (HR 2.1 [PDRS<0.001] and 2.3 [POS<0.001]) and NP-BC (HR 2.1 [PDRS<0.001] and 2.0 [POS<0.001]) patients. Prognosis was poorest for PP-BCPW patients who did not breastfeed or only for ≤ 3 months before diagnosis. This could not fully be attributed to differences in standard prognostic characteristics. In addition, PP-BCPW tumours showed a 3- to 8-fold increased risk to metastasise to the liver, yet this did not correlate with the poor outcome of this patient cohort.
Breast cancer diagnosed shortly after weaning specifically adds to the poor prognosis in women diagnosed with PP-BC. Apart from the importance of an increased awareness, these data show that detailed lactation data need to be registered when breast cancer outcome in young women is investigated.
Clinicopathological data of 1180 young women with primary invasive breast cancer, diagnosed within 2 years postpartum (PP-BC), during pregnancy (Pr-BC), or nulliparous (NP-BC), were collected. For PP-BC patients, breastfeeding history was retrieved to differentiate breast cancers identified during lactation (PP-BCDL) from those diagnosed post-weaning (PP-BCPW). Differences in prognostic parameters, first site of distant metastasis, and risks for metastasis and death were determined between patient groups.
Cox proportional hazard models pointed to a twofold increased the risk of metastasis and death in PP-BCPW patients compared with PP-BCDL (hazard ratio [HR] 2.1 [PDRS = 0.021] and 2.9 [POS = 0.004]), Pr-BC (HR 2.1 [PDRS<0.001] and 2.3 [POS<0.001]) and NP-BC (HR 2.1 [PDRS<0.001] and 2.0 [POS<0.001]) patients. Prognosis was poorest for PP-BCPW patients who did not breastfeed or only for ≤ 3 months before diagnosis. This could not fully be attributed to differences in standard prognostic characteristics. In addition, PP-BCPW tumours showed a 3- to 8-fold increased risk to metastasise to the liver, yet this did not correlate with the poor outcome of this patient cohort.
Breast cancer diagnosed shortly after weaning specifically adds to the poor prognosis in women diagnosed with PP-BC. Apart from the importance of an increased awareness, these data show that detailed lactation data need to be registered when breast cancer outcome in young women is investigated.
摘要：
在年轻女性中，分娩后诊断为乳腺癌会增加转移和死亡的风险。对啮齿动物的研究表明，断奶后乳腺退化导致产后乳腺癌的预后不良。然而,这种关联尚未在人类中进行过研究，主要是因为患者在诊断时的泌乳状况信息缺失。
1180例年轻女性原发性浸润性乳腺癌的临床病理资料,产后2年内诊断（PP-BC），怀孕期间（Pr-BC），或未产（NP-BC），被收集。对于PP-BC患者，我们检索了母乳喂养史,以区分哺乳期乳腺癌(PP-BCDL)和断奶后乳腺癌(PP-BCPW).预后参数的差异，远处转移的第一个部位，并确定患者组间的转移和死亡风险.
Cox比例风险模型指出，与PP-BCDL相比，PP-BCPW患者的转移和死亡风险增加了两倍（风险比[HR]2.1[PDRS=0.021]和2.9[POS=0.004]）。Pr-BC(HR2.1[PDRS<0.001]和2.3[POS<0.001])和NP-BC(HR2.1[PDRS<0.001]和2.0[POS<0.001])患者。未母乳喂养或仅在诊断前≤3个月的PP-BCPW患者的预后最差。这不能完全归因于标准预后特征的差异。此外,PP-BCPW肿瘤显示转移到肝脏的风险增加了3到8倍，然而,这与该患者队列的不良结局无关.
在断奶后不久诊断出的乳腺癌特别增加了诊断为PP-BC的女性的不良预后。除了提高认识的重要性，这些数据表明,在调查年轻女性乳腺癌结局时,需要登记详细的泌乳数据.
1180例年轻女性原发性浸润性乳腺癌的临床病理资料,产后2年内诊断（PP-BC），怀孕期间（Pr-BC），或未产（NP-BC），被收集。对于PP-BC患者，我们检索了母乳喂养史,以区分哺乳期乳腺癌(PP-BCDL)和断奶后乳腺癌(PP-BCPW).预后参数的差异，远处转移的第一个部位，并确定患者组间的转移和死亡风险.
Cox比例风险模型指出，与PP-BCDL相比，PP-BCPW患者的转移和死亡风险增加了两倍（风险比[HR]2.1[PDRS=0.021]和2.9[POS=0.004]）。Pr-BC(HR2.1[PDRS<0.001]和2.3[POS<0.001])和NP-BC(HR2.1[PDRS<0.001]和2.0[POS<0.001])患者。未母乳喂养或仅在诊断前≤3个月的PP-BCPW患者的预后最差。这不能完全归因于标准预后特征的差异。此外,PP-BCPW肿瘤显示转移到肝脏的风险增加了3到8倍，然而,这与该患者队列的不良结局无关.
在断奶后不久诊断出的乳腺癌特别增加了诊断为PP-BC的女性的不良预后。除了提高认识的重要性，这些数据表明,在调查年轻女性乳腺癌结局时,需要登记详细的泌乳数据.
