Abstract：
Early-onset diagnosis, defined by age <40 years, has historically been associated with inferior outcomes in breast cancer. Recent evidence suggests that this association is modified by molecular subtype. We performed a systematic review and meta-analysis of the literature to synthesize evidence on the association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer (TNBC). Studies comparing the risk of clinical outcomes in non-metastatic TNBC between early-onset patients and later-onset patients (≥40 years) were queried in Medline and EMBASE from inception to February 2023. Separate meta-analyses were performed for breast cancer specific survival (BCSS), overall survival (OS), and disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and pathological complete response (pCR). In total, 7581 unique records were identified, and 36 studies satisfied inclusion criteria. The pooled risk of any recurrence was significantly greater in early-onset patients compared to later-onset patients. Better BCSS and OS were observed in early-onset patients relative to later-onset patients aged >60 years. The pooled odds of achieving pCR were significantly higher in early-onset patients. Future studies should evaluate the role of locoregional management of TNBC and the implementation of novel therapies such as PARP inhibitors in real-world settings, and whether they improve outcomes.
摘要：
早期诊断,定义为年龄<40岁，从历史上看，乳腺癌的预后较差。最近的证据表明，这种关联被分子亚型修饰。我们对文献进行了系统回顾和荟萃分析，以综合三阴性乳腺癌（TNBC）的早发性诊断与临床结局之间关联的证据。从开始到2023年2月，在Medline和EMBASE中查询了比较早发性患者和晚发性患者（≥40岁）之间非转移性TNBC临床结局风险的研究。对乳腺癌特异性生存率(BCSS)进行了单独的荟萃分析，总生存期（OS），和无病生存率（DFS），局部无复发生存率（LRRFS），远端无复发生存率（DRFS），病理完全缓解(pCR)。总的来说,确定了7581条独特记录，36项研究符合纳入标准。与晚期患者相比，早期患者的任何复发的合并风险均显着更高。相对于年龄>60岁的迟发型患者,在早发型患者中观察到更好的BCSS和OS。在早发型患者中，达到pCR的合并几率明显更高。未来的研究应该评估TNBC局部区域管理的作用以及在现实环境中实施新疗法如PARP抑制剂。以及它们是否会改善结果。
