PDF(Pubmed)
Abstract：
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.
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.
摘要：
在45岁之前（<45岁）和产后前5年内被诊断患有乳腺癌的妇女（产后乳腺癌，PPBC）具有最大的远端转移性复发风险。
来自科罗拉多州年轻女性乳腺癌队列和乳腺癌健康差异研究的汇总数据（N=2519例），我们检查了平价的关联，年龄,和临床因素与乳腺癌总生存期（OS）超过15年的随访。
在45岁以下诊断为PPBC的女性的OS最低（p<0.0001），而在<45岁时诊断的未产病例的OS与在45-65岁时诊断的病例的OS没有差异，无论胎次状态如何。调整研究地点后，种族/民族,临床分期,雌激素受体状态的诊断和分层年份，PPBC仍然是与OS差相关的独立因素。在诊断为<45岁的病例中，与PPBC相比，未产病例的OS（风险比（HR）=0.61，95CI0.42-0.87）高1.6倍，I期乳腺癌之间的生存差异更为明显（HR=0.30，95CI0.11-0.79）。在年龄≤35岁的非常年轻的女性中，与PPBC相比，未产病例的OS提高了2.3倍（HR=0.44，95CI0.23-0.84）。
我们的结果表明，产后状况是年轻乳腺癌女性预后不良的主要驱动因素，在年龄≤35岁的患者和患有I期疾病的患者中，相关性最强。
来自科罗拉多州年轻女性乳腺癌队列和乳腺癌健康差异研究的汇总数据（N=2519例），我们检查了平价的关联，年龄,和临床因素与乳腺癌总生存期（OS）超过15年的随访。
在45岁以下诊断为PPBC的女性的OS最低（p<0.0001），而在<45岁时诊断的未产病例的OS与在45-65岁时诊断的病例的OS没有差异，无论胎次状态如何。调整研究地点后，种族/民族,临床分期,雌激素受体状态的诊断和分层年份，PPBC仍然是与OS差相关的独立因素。在诊断为<45岁的病例中，与PPBC相比，未产病例的OS（风险比（HR）=0.61，95CI0.42-0.87）高1.6倍，I期乳腺癌之间的生存差异更为明显（HR=0.30，95CI0.11-0.79）。在年龄≤35岁的非常年轻的女性中，与PPBC相比，未产病例的OS提高了2.3倍（HR=0.44，95CI0.23-0.84）。
我们的结果表明，产后状况是年轻乳腺癌女性预后不良的主要驱动因素，在年龄≤35岁的患者和患有I期疾病的患者中，相关性最强。
