Abstract
Objective. To elucidate the impact of clinical-pathological factors on overall survival (OS) in patients who got pregnant after breast cancer treatment. Methods. Retrospective cohort of women age younger than 40 years with breast cancer history without active disease at diagnosis of postcancer pregnancy. Clinical-pathological factors were analized by age group and recent birth. Overall survival (OS) was evaluated from Kaplan-Meier method. The association between clinical-pathological factors and OS was examined using Cox proportional hazards method to estimate hazard ratio (HR) with 95% confidence intervals (CI). Results: A total of 14 patients were selected. Median age was 28.5 years (interquartile range, 26-35). Locally advanced stage (IIB-IIIB) was diagnosed in 64.3%. Patients lower than 35 years experienced more positive clinical lymph nodes (72.7%), grade 2 (63.6%) and ER/PgR-negative tumors (54.5% and 72.7%, respectively). The patients with ER-positive tumors showed an improvement non-significant at 5-year OS (87%; p = 0.097). In the bivariate analysis, patients with a higher number of pathological lymph nodes (pNs) had a 12% increase in the risk of death than those with lower number (HR = 1.12; 95% CI: 1.02 to 1.2). The multivariate model (after adjustment for number of pNs, age and tumor size) ascertained that the nodal status was the only independent predictor associated to a worse OS (HR = 1.15; 95% CI: 1.01 to 1.3). Conclusion. Pregnancy after cancer did not have a detrimental effect on survival. The patients < 35 years old group showed more unfavorable tumor features at diagnosis, which can largely explain a poorer prognosis. Nodal status was the most important prognostic factor that predicted the poor prognosis.
Highlights
Breast cancer (BC) usually affects women at perimenopause and postmenopausal age; approximately 7% to 16.2% of all BC cases are diagnosed in women younger than 40 years [1,2,3,4,5]
Patients with a higher number of pathological lymph nodes had a 12% increase in the risk of death than those with lower number (HR = 1.12; 95% confidence intervals (CI): 1.02 to 1.2)
The multivariate model ascertained that the nodal status was the only independent predictor associated to a worse overall survival (OS) (HR = 1.15; 95% CI: 1.01 to 1.3)
Summary
Breast cancer (BC) usually affects women at perimenopause and postmenopausal age; approximately 7% to 16.2% of all BC cases are diagnosed in women younger than 40 years [1,2,3,4,5]. Women age younger than 45 years who have survived following BC treatment have been able to conceive 6-22 with low pregnancy rates (3% to 8%) [8,9,10,11,12,13, 15, 20]. Many studies have pointed that women with a post-cancer pregnancy appear to have a better prognosis compared with those did not [6,7,8,9,10,11,12,13,14,15,16,17]. Several studies have revealed that young women are more likely to develop unfavorable tumor histopathological features and more aggressive subtypes [1,2,3,4,5]
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