背景:在非常年轻的患者中,缺乏探索早期乳腺癌(eBC)的数据。与36至50岁的对照组相比,我们评估了大量年龄≤35岁的患者的共同和内在预后因素。
方法:在1990年至2014年期间接受初次手术的23,134例eBC患者的多中心队列中,对≤50例患者进行了回顾性分析。建立了DFS和OS的多变量Cox分析。评估年龄的独立影响,对≤35和36-50岁的患者进行1至3例病例对照分析。
结果:在6481名患者中,556岁≤35岁,5925岁从36岁到50岁。年龄≤35岁与较大的肿瘤有关,更高等级,ER消极,宏观淋巴结受累(pN+宏观),淋巴管浸润(LVI),乳房切除术,和化疗(CT)的使用。在多变量分析中,年龄≤35岁与DFS恶化相关[HR1.56,95%CI1.32-1.84;p<0.001],和OS[HR1.29,95%CI1.03-1.60;p=0.025],就像高年级一样,大肿瘤,LVI,pN+宏,ER消极,诊断期,和缺乏ET或CT(对于DFS)。在DFS的病例对照匹配分析中,年龄≤35岁对预后有不利影响[HR1.56,95CI1.28-1.91,p<0.001],和OS[HR1.33,95CI1.02-1.73,p=0.032]。当仅考虑患者≤35时,ER,肿瘤大小,节点状态,LVI和LVI与本亚组的生存率独立相关.
结论:年龄≤35岁与不良表现和更积极的治疗策略相关。我们的结果支持年轻时的不良预后价值,在调整其他预后因素和治疗时,这种情况独立存在。
BACKGROUND: There is a scarcity of data exploring early breast cancer (eBC) in very young patients. We assessed shared and intrinsic prognostic factors in a large cohort of patients aged ≤35, compared to a control group aged 36 to 50.
METHODS: Patients ≤50 were retrospectively identified from a multicentric cohort of 23,134 eBC patients who underwent primary surgery between 1990 and 2014. Multivariate Cox analyses for DFS and OS were built. To assess the independent impact of age, 1 to 3
case-control analysis was performed by matching ≤35 and 36-50 years patients.
RESULTS: Of 6481 patients, 556 were aged ≤35, and 5925 from 36 to 50. Age ≤35 was associated with larger tumors, higher grade, ER-negativity, macroscopic lymph node involvement (pN + macro), lymphovascular invasion (LVI), mastectomy, and chemotherapy (CT) use. In multivariate analysis, age ≤35 was associated with worse DFS [HR 1.56, 95% CI 1.32-1.84; p < 0.001], and OS [HR 1.29, 95% CI 1.03-1.60; p = 0.025], as were high grade, large tumor, LVI, pN + macro, ER-negativity, period of diagnostic, and absence of ET or CT (for DFS). Adverse prognostic impact of age ≤35 was maintained in the
case control-matched analysis for DFS [HR 1.56, 95%CI 1.28-1.91, p < 0.001], and OS [HR 1.33, 95%CI 1.02-1.73, p = 0.032]. When only considering patients ≤35, ER, tumor size, nodal status, and LVI were independently associated with survival in this subgroup.
CONCLUSIONS: Age ≤35 is associated with less favorable presentation and more aggressive treatment strategies. Our results support the poor prognosis value of young age, which independently persisted when adjusting for other prognostic factors and treatments.