目的: 分析绝经前乳腺癌不同年龄段病人的临床病理特征及辅助治疗方案选择的差异。方法: 回顾性分析2009年1月至2016年12月就诊的571例绝经前乳腺癌病人,收集其临床病理资料以及辅助治疗方案。根据年龄,分为≤35岁（44例）、36~40岁（86例）和>40岁（441例）三组,比较组间临床病理特征以及治疗方案的差异。结果: 分析显示,体质量指数（body mass index, BMI）以及HER2阳性率在三组间具有显著差异（P<0.05）。进一步两两比较发现,BMI>25的比例在≤35岁组显著低于其他两组;≤35岁组的HER2阳性率为20.45%,显著高于36~40岁组（12.79%）和>40岁组（15.87%）。在外科治疗方面,≤35岁组较多选择保乳手术（22.73%）和前哨淋巴结手术（43.18%）;而在术后辅助化疗、放疗、内分泌治疗和靶向治疗方面,三组间无统计学差异。>40岁组卵巢功能抑制应用少于其他两组（P<0.001）。结论: 在绝经前乳腺癌病人中,≤35岁组BMI较低,HER2阳性率较高,较多接受保乳手术和前哨淋巴结手术。
Objective To analyze clinicopathological features and selection of adjunctive treatment by different age in premenopausal breast cancer. Methods The data of clinicopathological feature and adjunctive therapy were collected from 571 premenopausal women with breast cancer between January 2009 and December 2016. The patients were divided into 3 groups: 44 cases in group 1, age ≤35, 86 cases in group 2, age 36-40, and 441 cases in group 3, age >40. Clinicopathological feature and adjunctive therapy were compared for the difference among 3 groups. Results It was shown that there were significant differences in body mass index (BMI) and positive HER2 rate among 3 groups (P<0.05). Less patients in group 1 had BMI >25 compared with the patients in other 2 groups. HER2 positive rate of patients in group 1 was 20.45%, much more than in other 2 groups (12.79% in group 2 and 15.87% in group 3). More patients in group 1 selected breast-conserving surgery (22.73%) and sentinel lymph node biopsy (43.18%). There was no statistical difference in postoperative adjunctive chemotherapy, radiotherapy, endocrine therapy and targeted therapy among 3 groups. Less patients in group 3 received ovarian function suppression compared with the other 2 groups(P<0.001). Conclusions It was indicated in this study that patients ≤35 years old with premenopausal breast cancer had lower BMI and higher HER2 positive rate, and they preferred breast-conserving surgery and sentinel lymph node biopsy.
[1] Siegel RL, Miller KD, Jemal A.Cancer statistics, 2016[J]. CA Cancer J Clin,2016,66(1):7-30.
[2] Ferlay J, Soerjomataram I, Dikshit R, et al.Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012[J]. Int J Cancer,2015,136(5):E359-E386.
[3] Narod SA.Breast cancer in young women[J]. Nat Rev Clin Oncol,2012,9(8):460-470.
[4] Chollet-Hinton L, Anders CK, Tse CK, et al.Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: a case-control study[J]. Breast Cancer Res,2016,18(1):79.
[5] Kataoka A, Iwamoto T, Tokunaga E, et al.Young adult breast cancer patients have a poor prognosis independent of prognostic clinicopathological factors: a study from the Japanese Breast Cancer Registry[J]. Breast Cancer Res Treat,2016,160(1):163-172.
[6] Warner ET, Colditz GA, Palmer JR, et al.Reproductive factors and risk of premenopausal breast cancer by age at diagnosis: are there differences before and after age 40?[J]. Breast Cancer Res Treat,2013,142(1):165-175.
[7] Collins LC, Marotti JD, Gelber S, et al.Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer[J]. Breast Cancer Res Treat,2012,131(3):1061-1066.
[8] Kroman N, Tutt A, Jensen MB, et al.Factors influencing the effect of age on prognosis in breast cancer: population based study[J]. BMJ,2000,320(7233):474-478.
[9] Liukkonen S, Leidenius M, Saarto T, et al.Breast cancer in very young women[J]. Eur J Surg Oncol,2011,37(12):1030-1037.
[10] 中国抗癌协会乳腺癌诊治指南与规范(2017年版). 中国癌症杂志[J]. 2017,27(9):710-731.
[11] Akarolo-Anthony S, Ogundiran TO, Adebamowo CA. Emerging breast cancer epidemic: evidence from Africa[J]. Breast Cancer Res,2010,12 Suppl 4:S8.
[12] 张柏林, 张倩, Sivasubramaniam P, 等. 中国年轻乳腺癌发病危险因素-多中心十年回顾性研究[J]. 中国肿瘤, 2015,24(12):1042-1047.
[13] Han W, Kang SY.Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer[J]. Breast Cancer Res Treat,2010,119(1):193.
[14] Azim HA Jr, Michiels S, Bedard PL, et al.Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling[J]. Clin Cancer Res,2012,18(5):1341-1351.
[15] Azim HA Jr, Partridge AH.Biology of breast cancer in young women[J]. Breast Cancer Res,2014,16(4):427.
[16] Shimizu C.Breast cancer in young women: its biological and clinical uniqueness and needs of comprehensive care[J]. Breast Cancer,2014,21(6):641-642.
[17] Lundin J, Lehtimaki T, Lundin M, et al.Generalisability of survival estimates for patients with breast cancer--a comparison across two population-based series[J]. Eur J Cancer,2006,42(18):3228-3235.
[18] 陈宏亮, 吴克瑾. 年轻女性乳腺癌外科处理的热点[J].外科理论与实践,2017,22(5):384-388.
[19] Kümmel A, Kümmel S, Barinoff J, et al.Prognostic factors for local, loco-regional and systemic recurrence in early-stage breast cancer[J]. Geburtshilfe Frauenheilkd,2015,75(7):710-718.
[20] Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials[J]. Lancet,2011,378(9804):1707-1716.
[21] Quan ML, Paszat LF, Fernandes KA, et al.The effect of surgery type on survival and recurrence in very young women with breast cancer[J]. J Surg Oncol,2017,115(2):122-130.
[22] 崔宁. 年轻乳腺癌患者保乳手术后的局部复发及总体预后情况分析[J]. 中国现代普通外科进展,2015,18(5):373-377.
[23] LHRH-agonists in Early Breast Cancer Overview group, Cuzick J, Ambroisine L, et al. Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials[J]. Lancet,2007,369(9574):1711-1723.
[24] Francis PA, Regan MM, Fleming GF, et al.Adjuvant ovarian suppression in premenopausal breast cancer[J]. N Engl J Med,2015,372(5):436-446.
[25] Scharl A, Salterberg A, Untch M, et al.Treatment modification in young breast cancer patients[J]. Oncol Res Treat,2016,39(3):122-128.
