Abstract
Young age (≤40 years) use to be considered an independent risk factor for the prognosis of women with early-stage breast cancer. We conducted a retrospective analysis to investigate this claim in a population of young patients who were stratified by molecular subtype. We identified 2,125 women with stage I to III breast cancer from the Fujian Medical University Union Hospital. Multivariable Cox proportional hazards models were used to analyze the relationship between age groups stratified by molecular subtype and 5-year disease-free survival (DFS), 5-year distant metastasis-free survival (DMFS), and 5-year breast cancer-specific survival (BCSS). Median follow-up time was 77 months. Patients ≤40 years of age presented with a significantly worse 5-year DFS and 5-year DMFS. In stratified analyses, young women with luminal A subtype disease were associated with a worse 5-year DFS, 5-year DMFS, and 5-year BCSS. Women with luminal B (Her2−) tumors showed a decrease in 5-year DFS and 5-year DMFS. Our findings support the hypothesis that young age seems to be an independent risk factor for the prognosis for breast cancer patients with the luminal A and luminal B (Her2−) subtypes but not in those with luminal B (Her2+), Her2 over-expression, and triple-negative disease.
Highlights
Breast cancer is the most common cause of death from carcinomas in women in developing countries, and it is the second most common cause in women in developed countries[1]
This study retrospectively investigated the effect of age on the prognosis of breast cancer, and most importantly, explored whether young age is always an independent risk factor for disease-free survival (DFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) in patients with different molecular subtypes of early-stage breast cancer
With multivariable analysis using the Cox’s proportional hazards model after controlling for tumor stage, molecular subtype and treatment, we found that the 5-year DFS of the younger group is 1.37-fold higher than for women from 41 to 50 year old at diagnosis (HR = 1.37, 95%CI 1.12–1.67, Table 2a)
Summary
Breast cancer is the most common cause of death from carcinomas in women in developing countries, and it is the second most common cause in women in developed countries[1]. Breast cancer accounts for approximately 5–7% in developed countries among younger women (≤40 years old), it is accounts for about 20% in the same population in China[2,3,4] This suggests that different geographic regions and ethnicities have different age structure. Several large studies have reported that young age seems to indicate an unfavorable prognosis at the diagnosis of breast cancer, and performs as an independent risk factor in patients for a higher risk of recurrence and death[5,6,7,8,9]. Younger women with breast cancer are more likely to develop more aggressive subtypes, which include a higher proportion of basal-like and HER2 over-expressing tumors that are associated with a poor prognosis[9, 16]. New diagnoses and treatment strategies for clinical use may become available after applying the results of this study
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