Abstract
Background Breast cancer has both aggressive clinicopathological characteristics and a poor prognosis in young females. However, limited information is available for breast cancer in Chinese females aged ≤25 years. Therefore, we aimed to explore prognostic factors for invasive disease-free (iDFS) and overall survival (OS) among breast cancer patients aged ≤25 years. Methods We retrospectively analyzed data from 174 Chinese females aged ≤25 years with invasive breast cancer treated in the Cancer Hospital of the Chinese Academy of Medical Sciences from January 1, 1999, to December 31, 2018. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors. Results The median follow-up time was 75 months (ranging from 1 to 236 months). Breast cancer patients aged ≤25 years exhibited aggressive clinicopathological characteristics, including advanced tumor stage (21.8%), lymph node metastasis (47.1%), lymphovascular invasion (24.1%), estrogen receptor negativity (44.3%), progesterone receptor (PR) negativity (42.5%), and triple-negative breast cancer (25.3%). Among them, 50 cases had locoregional recurrence and metastasis, 20 had bilateral invasiveness, and 33 had breast cancer-specific deaths. Cox multivariate analysis identified that diagnosis delay, PR status, and radiotherapy were significant prognostic factors for both iDFS and OS (P < 0.05). The risk of recurrence and metastasis was five times higher in N3 than in N0 (HR: 6.778, 95% CI: 2.268–17.141, P < 0.001). Patients with lymphovascular invasion had a threefold increase in the risk of breast cancer-specific death (HR: 4.217, 95% CI: 1.956–9.090, P < 0.001). No differences were observed between mastectomy and breast-conserving surgery (BCS) plus radiotherapy for iDFS or OS (iDFS: χ2 = 0.678, P=0.410; OS: χ2 = 0.165, P=0.685). Conclusions Breast cancer in females ≤25 years old was associated with aggressive clinical features and a worse prognosis. Young females with breast lumps should receive timely diagnosis and treatment. Young breast cancer patients with lymphovascular invasion, PR-negative status, and lymph node metastasis have an increased risk of experiencing recurrence and metastasis and should hence be closely monitored. Age at diagnosis should not be the sole deciding factor for surgical treatment methods.
Highlights
Breast cancer has both aggressive clinicopathological characteristics and a poor prognosis in young females
There are breast cancer patients aged ≤25 years known as very young breast cancer (VYBC) patients. e incidence of VYBC ranges from 0.4% to 1.2% [3,4,5,6]
50 (28.7%) patients were diagnosed with a delay of ≥6 months. ere were 25 cases of pregnancy-associated breast cancer (PABC), 7 (28.0%) during pregnancy and 18 (72.0%) within one year after delivery
Summary
Breast cancer has both aggressive clinicopathological characteristics and a poor prognosis in young females. Breast cancer patients aged ≤25 years exhibited aggressive clinicopathological characteristics, including advanced tumor stage (21.8%), lymph node metastasis (47.1%), lymphovascular invasion (24.1%), estrogen receptor negativity (44.3%), progesterone receptor (PR) negativity (42.5%), and triple-negative breast cancer (25.3%). Young breast cancer patients with lymphovascular invasion, PRnegative status, and lymph node metastasis have an increased risk of experiencing recurrence and metastasis and should be closely monitored. VYBC has aggressive clinical and pathological features and is more likely to develop tumors of a larger size, have higher lymph node positivity rates, present with more advanced stages, have increased lymphovascular invasion, have higher histological grades, have lower hormone receptor positivity rates, have overexpression of the human epidermal growth factor receptor 2 (HER2), and have a higher proportion of triplenegative breast cancer (TNBC) [5, 6, 13]. Some studies suggest that aggressive clinicopathological features are significant prognostic factors for VYBC [3, 5, 13]
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