Abstract
Purpose: We aimed to assess the effect of age on survival according to estrogen receptor (ER) and progesterone receptor (PR)-defined lobular breast cancer subtype in a wide age range.Methods: 43,230 invasive lobular breast cancer women without comorbidities diagnosed between 2004 and 2011 in the National Cancer Database (NCDB) were analyzed. The effects of age on overall survival (OS) among different age groups were evaluated by log-rank test and Cox proportional model.Results: Multivariate analysis showed that patients diagnosed at both young (<35 years) and old (≥70 years) ages had worse prognosis compared with those in the middle ages. We further analyzed the interaction between age and molecular subtype for predicting OS: in ER+PR+ subtype, the HR of OS declined with age from 1.55 (95% CI, 1.08–2.22; P = 0.019) in the group younger than 35 years to 1.38 (1.02–1.86; P = 0.036) in the 35–39 group, but increased with age to 10.1 (8.49–11.94; P < 0.001) in the group older than 79. While in ER+PR- and ER-PR- subtypes, the HRs showed no statistical differences among women diagnosed before 60 (P > 0.1); and in ER-PR+ subgroup, the HRs were similar in patients younger than 70 (P > 0.1); thus, the plots of HRs in these three subtypes remained steady until the age of 60 or 70.Conclusions: Our findings identified that the effect of age on OS in lobular breast cancer varied with ER/PR-defined subtypes. Personalized treatment strategies should be developed to improve outcomes of breast cancer patients with different ages and ER/PR statuses.
Highlights
Breast cancer is known to be a heterogeneous disease, which exhibits distinct clinical presentations, aggressiveness, treatment response, as well as outcomes among different subtypes of breast cancer
Of the 43,230 primary invasive lobular breast cancer patients with no comorbid conditions included in this study, 27,962 (64.7%) patients had estrogen receptor (ER)+progesterone receptor (PR)+ tumors, 5,000 (11.5%) patients had ER+PR- disease, 585 (1.4%) women had ER-PR+ cancers, and 9,683 (22.4%)
After adjusting for known breast cancer prognostic factors and multiple treatment variables, we demonstrated that patients who were diagnosed with invasive lobular breast cancer at both very young (
Summary
Breast cancer is known to be a heterogeneous disease, which exhibits distinct clinical presentations, aggressiveness, treatment response, as well as outcomes among different subtypes of breast cancer. Several retrospective studies showed that invasive lobular breast cancer was less responsive than ductal carcinoma to chemotherapy [13,14,15]; and a recent analysis of BIG 1–98 trial demonstrated that the benefit of adjuvant letrozole was greater for postmenopausal women diagnosed with lobular carcinoma versus ductal carcinoma [16]. We hypothesized that age may have a more complicated prognostic impact on survival outcomes than prior realized in this particular histological type of breast cancer
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