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Wang J, Liu Y, Liang Y, Zhang Y, Dong H, Zheng T, Yu J, Du P, Jia S, King BL, Wang J, Liu X, Li H. Clinicopathologic features, genomic profiles and outcomes of younger vs. older Chinese hormone receptor-positive (HR+)/HER2-negative (HER2-) metastatic breast cancer patients. Front Oncol 2023; 13:1152575. [PMID: 37361577 PMCID: PMC10286822 DOI: 10.3389/fonc.2023.1152575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Poor outcomes have been widely reported for younger vs. older breast cancer patients, but whether this is due to age itself or the enrichment of aggressive clinical features remains controversial. We have evaluated the clinicopathologic characteristics and genomic profiles of real-world hormone receptor-positive (HR+)/HER2-negative (HER2-) metastatic breast cancer (MBC) patients to examine the determinants of outcome for younger vs. older patients in a single clinical subtype undergoing treatment in the same clinic. Patients and methods This study included patients presenting at the Peking University Cancer Hospital with primary stage IV or first-line metastatic HR+/HER2- breast cancer who consented to an additional blood draw for genomic profiling prior to treatment. Plasma samples were analyzed with a targeted 152-gene NGS panel to assess somatic circulating tumor DNA (ctDNA) alterations. Genomic DNA (gDNA) extracted from peripheral blood mononuclear cells was analyzed for germline variants using a targeted 600-gene NGS panel. Kaplan-Meier survival analysis was performed to analyze disease free survival (DFS), progression free survival (PFS) and overall survival (OS) in association with clinicopathologic and genomic variables. Results Sixty-three patients presenting with HR+/HER2- MBC were enrolled in this study. Fourteen patients were < 40 years, 19 were 40-50 years, and 30 were > 50 years at the time of primary cancer diagnosis. No significant associations were observed between age and DFS, PFS or OS. Shorter OS was associated with de novo Stage IV disease (p = 0.002), Luminal B subtype (p = 0.006), high Ki67 index (p = 0.036), resistance to adjuvant endocrine therapy (p = 0.0001) and clinical stage (p = 0.015). Reduced OS was also observed in association with somatic alterations in FGFR1 (p = 0.008), CCND2 (p = 0.012), RB1 (p = 0.029) or TP53 (p = 0.029) genes, but not in association with germline variants. Conclusion In this group of real-world HR+/HER2- MBC breast cancer patients younger age was not associated with poor outcomes. While current guidelines recommend treatment decisions based on tumor biology rather than age, young HR+ breast cancer patients are more likely to receive chemotherapy. Our findings support the development of biomarker-driven treatment strategies for these patients.
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Affiliation(s)
- Jinhao Wang
- Huidu Shanghai Medical Sciences Ltd., Shanghai, China
| | - Yaxin Liu
- Key Laboratory of Carcinogenesis and Translational Research, Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuehua Liang
- Key Laboratory of Carcinogenesis and Translational Research, Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yue Zhang
- Huidu Shanghai Medical Sciences Ltd., Shanghai, China
| | - Hang Dong
- Huidu Shanghai Medical Sciences Ltd., Shanghai, China
| | | | - Jianjun Yu
- Huidu Shanghai Medical Sciences Ltd., Shanghai, China
| | - Pan Du
- Predicine, Inc., Hayward, CA, United States
| | | | | | - Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research, Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research, Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research, Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Kim NH, Bang HW, Eom YH, Choi SH. The different prognostic impact of age according to individual molecular subtypes in breast cancer. Ann Surg Treat Res 2022; 103:129-144. [PMID: 36128031 PMCID: PMC9478429 DOI: 10.4174/astr.2022.103.3.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Young age at diagnosis has been considered a poor prognostic factor. However, considering young age itself as an independent poor prognostic factor for all breast cancers is unwarranted. We analyzed the different prognostic effects of age as a prognostic factor according to molecular subtype. Methods We retrieved data from 1,819 patients with primary breast cancer at the breast cancer center between 2007 and 2012. We classified each molecular subtype in 3 age cohorts (<40, 40–50, and >50 years). The associations of age and molecular subtypes with relapse-free survival (RFS) and disease-specific survival (DSS) were assessed. Results Patients aged <40 years showed a poor histologic grade, hormone receptor negative expression than older patients, and had a higher proportion of triple-negative breast cancer (TNBC) (P < 0.001). This was thought to have led to a significantly shorter RFS than that of older patients (P < 0.001). In the subgroup analysis according to molecular subtypes, the poorer RFS was observed only in patients aged <40 years with luminal type breast cancer (P < 0.001). Age was an independent prognostic factor of RFS in luminal-type breast cancer (P = 0.001). However, no difference in RFS between age groups was found for patients with other subtypes (human epidermal growth factor receptor 2 overexpression, TNBC). No significant effect between age groups was found in DSS for patients with all molecular subtypes. Conclusion Age at diagnosis of breast cancer affected prognosis differently according to molecular subtype. Age itself is not an independent prognostic factor. Age of <40 years showed a limited worse prognostic impact of recurrence in luminal type breast cancer only.
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Affiliation(s)
- Nam Hee Kim
- Division of Breast Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Won Bang
- Division of Breast Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Hwa Eom
- Division of Breast Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hye Choi
- Division of Breast Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zhu J, Zheng H, Ge C, Lin H, Yu K, Wu L, Li D, Zhou S, Tang W, Wang Q, Zhang X, Jin X, Xu X, Du J, Fu J. Competing Nomogram for Late-Period Breast Cancer-Specific Death in Patients with Early-Stage Hormone Receptor-Positive Breast Cancer. Clin Breast Cancer 2021; 22:e296-e309. [PMID: 34627728 DOI: 10.1016/j.clbc.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than half of early breast cancer recurrences occur after 5 years from the initial diagnosis. An individualized estimate of the risk of late-period breast cancer-specific death (LP-BCSD) after 5 years of endocrine therapy (ET) can improve decision-making for extended endocrine therapy (EET). MATERIALS AND METHODS A total of 147,059 eligible patients with breast cancer who survived 5+ years after diagnosis between 1990 and 2007 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses based on the competing risk regression model were used to evaluate predictive factors for high risk of LP-BCSD or late-period non-breast cancer-specific death (LP-non-BCSD). Significant factors were used to build a nomogram to individualize estimates of LP-BCSD or LP-non-BCSD. RESULTS The 5- and 10-year LP-BCSD rates were 5.7% and 10.1%, respectively, and the 5- and 10-year LP-non-BCSD rates were 6.7% and 15.5%, respectively. Young age, black race, single marital status, poor differentiation, large tumor size, lymph node metastasis, and estrogen receptor-positive/progesterone receptor-negative (ER+/PR-) status were independent predictive factors for high risk of LP-BCSD. Age was the most important factor for predicting high risk of LP-non-BCSD. The nomograms, which were based on significant factors identified by the competing risk regression model. A risk score system based on the competing risk nomogram was established to describe the relative risk of LP-BCSD and LP-non-BCSD. CONCLUSION This study explored the novel endpoint of LP-BCSD for further clinical trials. The risk score system might be highly useful for patient counseling, especially in discussing EET options with elderly or comorbid patients.
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Affiliation(s)
- Jingjing Zhu
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Hongjuan Zheng
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Chenyang Ge
- Department of Colorectal Surgery, Jinhua hospital of Zhejiang University, Jinhua, Zhejiang Province, China
| | - Haiping Lin
- Department of Hepatobiliary Surgery, Jinhua hospital of Zhejiang University, Jinhua, Zhejiang Province, China
| | - Kaijie Yu
- Department of Neurosurgery, Jinhua hospital of Zhejiang University, Jinhua, Zhejiang Province, China
| | - Lunpo Wu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Dan Li
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shishi Zhou
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Wanfen Tang
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Qinghua Wang
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Xia Zhang
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Xiayun Jin
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Xifeng Xu
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
| | - Jinlin Du
- Department of Colorectal Surgery, Jinhua hospital of Zhejiang University, Jinhua, Zhejiang Province, China..
| | - Jianfei Fu
- Department of Medical Oncology, Jinhua hospital of Zhejiang University, Jinhua , Zhejiang Province, China
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4
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Zhang W, Zhang BL, He JJ, Fan JH, Li J, Zhang B, Yang HJ, Xie XM, Tang ZH, Li H, Li JY, Wang SL, Qiao YL, Huang R, Zhang P. Clinicopathological characteristics and treatment of young women with breast cancer in China: a nationwide multicenter 10-year retrospective study. Gland Surg 2021; 10:175-185. [PMID: 33633974 DOI: 10.21037/gs-20-574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Breast cancer is currently the most common female malignancy in China. However, the clinical features and overall prognosis of young women diagnosed with this malignancy remain unclear. This study aimed to describe the clinicopathological characteristics of young patients (≤34 years of age) with breast cancer and explore the current treatment approaches used in China. Methods This was a hospital-based, multicenter, retrospective study of women with breast cancer across seven Chinese hospitals from 1999 to 2008. A total of 295 young (≤34 years of age) patients (research group) and 2,119 women aged 35 to 49 years (control group) were included in the study. Patient epidemiology, pre-operative examinations, clinical pathology, and treatment were analyzed. Results The percentage of young patients with breast cancer in the study group was 7.01%. These young women had a lower body mass index (BMI), a higher level of education, a lower number of previous births, and a lower history of breastfeeding than the control group (P<0.05). Increasingly, pre-operative use of ultrasound and magnetic resonance imaging are being used to diagnose breast cancer in young women in China. In young women with breast cancer, breast cancer not otherwise specified (NOS) was the primary pathology. The carcinoma in young women was more prone to lymph node metastasis, showed less progesterone receptor (PR) expression, and was more advanced than observed in the control group (P<0.05). We found that the number of young breast cancer patients undergoing breast-conserving surgery in China is increasing. Conclusions Young breast cancer patients display unique clinicopathological features, including tumors of a higher grade than those aged 35 years or older. As breast cancer is more aggressive in younger women, prevention and early diagnosis are critical, and new policies should be developed in line with these findings.
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Affiliation(s)
- Wei Zhang
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bai-Lin Zhang
- Department of Breast Cancer, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union of Medical College, Beijing, China
| | - Jian-Jun He
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, China
| | - Bin Zhang
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Hong-Jian Yang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhong-Hua Tang
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Breast Surgery, the Second People's Hospital of Sichuan Province, Chengdu, China
| | - Jia-Yuan Li
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China
| | - Shu-Lian Wang
- Department of Radiotherapy, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Huang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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5
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Mustillo A, Ayoub JP, Charpentier D, Yelle L, Florescu M. Prognosis in young women less than 40 years of age with brain metastasis from breast cancer. ACTA ACUST UNITED AC 2020; 27:39-45. [PMID: 32218659 DOI: 10.3747/co.27.5621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Brain metastasis from breast cancer (bca) in young women is doubly devastating because both quality of life and life expectancy are significantly reduced. With new radiation technology and drugs that have emerged, survival is expected to increase for these young women. Methods Using the oacis and sardo patient databases, we identified 121 patients diagnosed with bca and brain metastasis between 2006 and 2016 at the University of Montreal Hospital Centre. Those patients were divided into Group A, patients who developed brain metastasis during the evolution of metastatic bca, and Group B, patients whose first metastasis was to the brain. For each group, we compared young patients (<40 years of age) with older patients (≥40 years of age). Results Among the 121 patients with brain metastasis, median overall survival (mos) was significantly longer for those less than 40 years of age than for those 40 or more years of age (18 months vs. 4 months, p < 0.001). With respect to the timing of brain metastasis, survival was significantly longer in Group B than in Group A (7 months vs. 4 months, p = 0.032). In Group A, mos was significantly longer for patients less than 40 years of age than for patients 40 or more years of age (18 months vs. 3 months, p = 0.0089). In Group B, the 2-year overall survival rate was 57% for patients less than 40 years of age and 12% for those 40 or more years of age (mos: not reached vs. 7 months; p = 0.259). Conclusions In our single-centre retrospective cohort of women with brain metastasis from bca, prognosis was better for young women (<40 years) than for older women (≥40 years). Survival was also longer for patients whose initial metastasis was to the brain than for patients whose brain metastasis developed later in the disease course. In patients who received systemic treatment, median survival remained significantly higher in women less than 40 years of age. Further studies are needed to validate those results.
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Affiliation(s)
- A Mustillo
- Department of Hematology and Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - J P Ayoub
- Department of Hematology and Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - D Charpentier
- Department of Hematology and Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - L Yelle
- Department of Hematology and Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M Florescu
- Department of Hematology and Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
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Zhang X, Yang J, Cai H, Ye Y. Young age is an independent adverse prognostic factor in early stage breast cancer: a population-based study. Cancer Manag Res 2018; 10:4005-4018. [PMID: 30310322 PMCID: PMC6166751 DOI: 10.2147/cmar.s167363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To compare the prognosis of young breast cancer patients with the older ones. Patients and methods Utilizing the Surveillance, Epidemiology, and End Results database, we identified 150,588 female breast cancer patients diagnosed during 2003–2014, including 6,668 patients younger than 35 years and 143,920 patients aged between 35 and 60 years. Kaplan– Meier analysis was performed to compare the prognosis of these two groups. Univariate and multivariate Cox proportional hazard models were utilized to identify independent prognostic factors and calculate the HR and 95% CI. Subgroup analysis was performed stratified according to the lymph node status and estrogen receptor (ER) status. Results The young patients presented with more aggressive clinicopathological characteristics, including larger tumor size (P<0.001), more lymph node metastasis (P<0.001), higher grade (grades III and IV, P<0.001), more ER/progesterone receptor absence (P<0.001), and more human epidermal growth factor receptor 2 overexpression (P<0.001). The patients younger than 35 years presented with inferior breast cancer-specific survival (BCSS) and overall survival (OS) (log-rank, P<0.001) in comparison with the older ones. In the multivariable Cox proportional hazard regression analysis, young age remained to be an independent adverse prognostic factor in operable breast cancer in terms of BCSS (HR, 1.200; 95% CI, 1.110–1.297; P<0.001) and OS (HR, 1.111; 95% CI, 1.032–1.196; P=0.005). In the subgroup analysis, young age remained a significant adverse prognostic factor in N0 (BCSS), N1, and ER-positive subgroups (P<0.05). Conclusion Young age is an independent adverse prognostic factor in operable breast cancer. Young patients may receive more intensive treatment than older ones.
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Affiliation(s)
- Xiao Zhang
- Department of Breast Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China,
| | - Jian Yang
- Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan 610064, China,
| | - Haoyang Cai
- Center of Growth, Metabolism, and Aging, Key Laboratory of Bio-Resources and Eco-Environment, College of Life Sciences, Sichuan University, Chengdu, Sichuan 610064, China,
| | - Yifeng Ye
- Department of Breast Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China,
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7
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Wong FY, Tham WY, Nei WL, Lim C, Miao H. Age exerts a continuous effect in the outcomes of Asian breast cancer patients treated with breast-conserving therapy. Cancer Commun (Lond) 2018; 38:39. [PMID: 29941044 PMCID: PMC6020242 DOI: 10.1186/s40880-018-0310-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Asians are diagnosed with breast cancer at a younger age than Caucasians are. We studied the effect of age on locoregional recurrence and the survival of Asian breast cancer patients treated with breast-conserving therapy. Methods Medical records of 2492 patients treated with breast-conserving therapy between 1989 and 2012 were reviewed. The Kaplan–Meier method was used to estimate locoregional recurrence, breast cancer-free survival, and breast cancer-specific survival rates. These rates were then compared using log-rank tests. Outcomes and age were modeled by Cox proportional hazards. Fractional polynomials were then used to test for non-linear relationships between age and outcomes. Results Patients ≤ 40 years old were more likely to have locoregional recurrence than were older patients (Hazard ratio [HR] = 2.32, P < 0.001). Locoregional recurrence rates decreased year-on-year by 4% for patients with luminal-type breast cancers, compared with 8% for those with triple-negative cancers. Similarly, breast cancer-free survival rates increased year-on-year by 4% versus 8% for luminal-type and triple-negative cancers, respectively. Breast cancer-specific survival rates increased with age by 5% year-on-year. Both breast cancer-free survival and breast cancer-specific survival rates in patients with luminal cancers exhibited a non-linear (“L-shaped”) relationship—where decreasing age at presentation was associated with escalating risks of relapse and death. The influence of age on overall survival was confounded by competing non-cancer deaths in older women, resulting in a “U-shaped” relationship. Conclusions Young Asian breast cancer patients have a continuous year-on-year increase in rates of disease relapse and cancer deaths compared with older patients with no apparent threshold.
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Affiliation(s)
- Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
| | - Wei Ying Tham
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Wen Long Nei
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Cindy Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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8
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Al-Janabi HT, Al-Taee HA, Alawad AS. The impact of age on antimullerian hormone serum level in women attending chemotherapy Unit for primary breast cancer. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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[Presentation and outcome of breast cancer under 40 years - A French monocentric study]. ACTA ACUST UNITED AC 2018; 46:105-111. [PMID: 29361410 DOI: 10.1016/j.gofs.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the impact of young age on breast cancer presentation and women's prognosis. METHODS We performed a descriptive retrospective study in the university teaching hospital of Tours from January 2007 to December 2013. All women managed for an invasive breast cancer were included. The population was divided in 2 groups according to age: ≤40 years and>40 years. We studied differences in histological, management and outcome characteristics. RESULTS Two thousand and eighty three women with an invasive breast cancer were included. A hundred and fifty five in the group of women with an age ≤40 years and 1928 in the group of women with an age>40 years. Histological characteristics of breast cancer in younger women were worse than in their older counterparts (with more aggressive features: grade 3, negative hormone receptors, positive Her 2 status, triple negative molecular sub-type). Overall survival was lower in young women than in women age>40 years (P=0.05),as was recurrence free survival (P<0.001), locoregional recurrence free survival (P=0.02) and distant metastasis free survival(P<0.001). Age≤40 years was an independent factor predictive of poor recurrence free survival. CONCLUSION In our study we found an impact of age≤40 years on invasive breast cancer presentation and prognosis.
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10
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Ordu C, McGuire K, Alco G, Nur Pilanci K, Koksal UI, Elbüken F, Erdogan Z, Agacayak F, Ilgun S, Sarsenov D, Öztürk A, İğdem Ş, Okkan S, Eralp Y, Dincer M, Ozmen V. The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer. Cureus 2016; 8:e633. [PMID: 27433412 PMCID: PMC4938212 DOI: 10.7759/cureus.633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. METHODS Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). RESULTS Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24-252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35-40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). CONCLUSION Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35-40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival.
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Affiliation(s)
- Cetin Ordu
- Medical Oncology, Gayrettepe Florence Nightingale Hospital
| | - Kandace McGuire
- General Surgery, University of North Carolina at Chapel Hill
| | - Gul Alco
- Radiation Oncology, Gayrettepe Florence Nightingale Hospital
| | | | | | | | - Zeynep Erdogan
- Physical Therapy and Rehabilitation, Istanbul Bilim University
| | | | - Serkan Ilgun
- General Surgery, Istanbul Florence Nightingale Hospital
| | | | - Alper Öztürk
- General Surgery, Istanbul Florence Nightingale Hospital
| | - Şefik İğdem
- Radiation Oncology, Gayrettepe Florence Nightingale Hospital
| | - Sait Okkan
- Radiation Oncology, Gayrettepe Florence Nightingale Hospital
| | - Yeşim Eralp
- Medical Oncology, Istanbul University/Oncology Institute
| | - Maktav Dincer
- Radiation Oncology, Gayrettepe Florence Nightingale Hospital
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11
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Kravchenko DS, Frolova EI, Kravchenko JE, Chumakov SP. Role of PDLIM4 and c-Src in breast cancer progression. Mol Biol 2016. [DOI: 10.1134/s002689331601009x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Yao Y, Cao M, Fang H, Xie J. Breast cancer in 30-year-old or younger patients: clinicopathologic characteristics and prognosis. World J Surg Oncol 2015; 13:38. [PMID: 25889848 PMCID: PMC4342820 DOI: 10.1186/s12957-015-0462-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of 30-year-old or younger patients with breast cancer is increasing. The aim was to describe the clinicopathological features and prognosis of 30-year-old or younger patients with breast cancer. METHODS We reviewed the records of 1,406 consecutive patients aged ≤50 years with first diagnosis of invasive breast cancer referred to surgery from March 2001 to March 2009. A total of 105 patients were aged ≤30 years (group I) and 1,301 were aged 31-50 years (group II). RESULTS Compared with patients of group II, patients of group I had a higher percentage of tumors classified as estrogen receptors (ER) negative (P < 0.001) and progesterone receptors (PR) negative (P = 0.043), with a Ki-67 labeling index ≥20% of the cells (P = 0.011). There was no difference between the two groups for pT and pN, histology, endocrine therapy, and chemotherapy. The 5-year survival of group I was 67.5% as compared with 75.3% for group II (P = 0.003). CONCLUSIONS Compared with patients aged between 31 and 50 years, patients aged ≤30 years have a greater chance of having an endocrine-unresponsive tumor and a significantly poor prognosis.
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Affiliation(s)
- Yongqiang Yao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
| | - Mingqian Cao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
| | - Hong Fang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
| | - JiPing Xie
- Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
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Bhatti ABH, Jamshed A, Khan A, Siddiqui N, Muzaffar N, Shah MA. Comparison between early and late onset breast cancer in Pakistani women undergoing breast conservative therapy: is there any difference? Asian Pac J Cancer Prev 2014; 15:5331-6. [PMID: 25040997 DOI: 10.7314/apjcp.2014.15.13.5331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early onset breast cancer is associated with poor outcomes but variable results have been reported. It is a significant problem in Pakistani women but remains under reported. Breast conservation plays an important role in surgical management of this younger patient group. The objective of this study was to determine the outcome of breast conservative therapy in patients with early onset breast cancer in our population and compare it with their older counterparts. MATERIALS AND METHODS A review of patients with invasive breast cancer who underwent breast conservation surgery at Shaukat Khanum Cancer Hospital from 1997 to 2009 was performed. Patients were divided into two groups i.e. Group I age ≤ 40 and Group II >40 years. A total of 401 patients with breast cancer were identified in Group I and 405 patients in Group II. Demographics, histopathological findings and receptor status of the two groups were compared. The Chi square test was used for categorical variables. Outcome was assessed on basis of 10 year locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS) . For survival analysis Kaplan Meier curves were used and significance was determined using the Log rank test. Cox regression was applied for multivariate analysis. RESULTS Median follow up was 4.31 (0.1-15.5) years. Median age at presentation was 34.6 years (17-40) and 51.9 years (41-82) for the two groups. Groups were significantly different from each other with respect to grade, receptor status, tumor stage and use of neoadjuvant therapy. No significant difference was present between the two groups for estimated 10 year LRRFS (86% vs 95%) (p=0.1), DFS (70% vs 70%) (p=0.5) and OS (75% vs 63%) (p=0.1). On multivariate analysis, tumor stage was an independent predictor of LRRFS, DFS and OS. CONCLUSIONS Early onset breast cancer is associated with a distinct biology but does not lead to poorer outcomes in our population.
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Affiliation(s)
- Abu Bakar Hafeez Bhatti
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town Lahore, Pakistan E-mail :
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Ekwueme DU, Guy GP, Rim SH, White A, Hall IJ, Fairley TL, Dean HD. Health and economic impact of breast cancer mortality in young women, 1970-2008. Am J Prev Med 2014; 46:71-9. [PMID: 24355674 PMCID: PMC5836720 DOI: 10.1016/j.amepre.2013.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 07/18/2013] [Accepted: 08/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer is the second-leading cause of cancer-related deaths among women aged <50 years. Studies on the effects of breast cancer mortality among young women are limited. PURPOSE To assess trends in breast cancer mortality rates among women aged 20-49 years, estimate years of potential life lost (YPLL), and the value of productivity losses due to premature mortality. METHODS Age-adjusted rates and rate ratios (RRs) were calculated using 1970-2008 U.S. mortality data. Breast cancer mortality rates over time were assessed using Joinpoint regression modeling. YPLL was calculated using number of cancer deaths and the remaining life expectancy at the age of death. Value of productivity losses was estimated using the number of deaths and the present value of future lifetime earnings. RESULTS From 1970 to 2008, the age-adjusted breast cancer mortality rate among young women was 12.02/100,000. Rates were higher in the Northeast (RR=1.03, 95% CI, 1.02-1.04). The annual decline in breast cancer mortality rates among blacks was smaller (-0.68%) compared with whites (-2.02%). The total number of deaths associated with breast cancer was 225,866, which accounted for an estimated 7.98 million YPLL. The estimated total productivity loss in 2008 was $5.49 billion and individual lifetime lost earnings were $1.10 million. CONCLUSIONS Considering the effect of breast cancer on women of working age and the disproportionate impact on black women, more age-appropriate interventions with multiple strategies are needed to help reduce these substantial health and economic burdens, improve survival, and in turn reduce productivity costs associated with premature death.
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Affiliation(s)
- Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.
| | - Gery P Guy
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Sun Hee Rim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Temeika L Fairley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Hazel D Dean
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease and Control Prevention, Atlanta, Georgia
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Alieldin NH, Abo-Elazm OM, Bilal D, Salem SE, Gouda E, Elmongy M, Ibrahim AS. Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis? J Egypt Natl Canc Inst 2013; 26:23-30. [PMID: 24565679 DOI: 10.1016/j.jnci.2013.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/25/2013] [Accepted: 08/28/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Primary objective was to verify whether breast cancer patients aged less than 40 years at diagnosis have poorer prognosis than older patients. Secondary to assess prognostic factors influencing disease free survival. METHODS 941 women were diagnosed with non-metastatic breast cancer at NCI, Cairo in 2003. Epidemiologic, clinico-pathological characteristics, treatment modalities and disease free survival were compared among the two age groups. Prognostic factors were evaluated for association with disease-free survival. RESULTS One hundred-eighty-one patients (19.2%) were younger than 40 years and 760 (80.8%) were older. Older women presented with higher rates of comorbidities and younger women presented with more hormone non-responsive tumors. Young women presented with larger tumors pT4=13.8% compared to 8.6% in older women, yet not significant. Young women were treated with more conservative surgery, more adjuvant chemotherapy and radiotherapy while older women with more radical mastectomies and more hormonal treatment. Recurrence rates were significantly higher among young women 44.2% compared to 34.5% in older women. Five year disease free survival in young women was 38.9% ± 4.6% compared to 48.6% ± 2.5% with adjusted hazard ratio of 1.22 95% CI (0.91-1.64), p=0.19. Multivariate analyses identified positive axillary lymph nodes (pN2-pN3), larger tumor size (pT3-pT4), hypertension, lobular carcinoma type and lack of adjuvant systemic treatment as independent factors associated with poor DFS. CONCLUSION Young women were not found to have poorer prognosis, yet they presented with more ER negative tumors. Most of women presented with advanced stage and young women had higher recurrence rates.
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Affiliation(s)
- Nelly H Alieldin
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt.
| | - Omnia M Abo-Elazm
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
| | - Dalia Bilal
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
| | - Salem Eid Salem
- Department of Medical Oncology, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
| | - Eman Gouda
- Department of Pathology, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
| | - Magda Elmongy
- Department of radiotherapy, NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
| | - Amal S Ibrahim
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute NCI, Cairo University, Fom Elkhalig Sq, Cairo, Egypt
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Age at diagnosis and breast cancer survival in iran. Int J Breast Cancer 2012; 2012:517976. [PMID: 23227345 PMCID: PMC3512268 DOI: 10.1155/2012/517976] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 09/26/2012] [Accepted: 10/14/2012] [Indexed: 01/23/2023] Open
Abstract
Background. Tumour characteristics are the most important prognostic factors in breast cancer. Patient-related factors such as young age at diagnosis, obesity, and smoking behaviour may also modify disease outcome. Due to the absence of a unique definition for "young age breast cancer" and the resulting variation in disease management, findings on the association between young age and prognosis of breast cancer are controversial. Methods. This study included 1500 patients with a primary diagnosis of breast cancer in six Iranian hospitals from 5 provinces. We modelled the relative excess risk (RER) of breast cancer death to age at diagnosis and tumour characteristics. Results. Excess risks of death were observed for stage IV disease and poorly differentiated tumours: RER of 4.3 (95% CI: 1.05-17.65) and 3.4 (95% CI: 1.17-9.87), respectively. "Older" patients, particularly those aged 50 and over, presented more often with advanced and poorly differentiated tumours (P = 0.001). After adjustment for stage, histological grade, Her-2 expression, estrogen and progesterone receptors, and place of residency, breast cancer mortality was not significantly different across age groups. Conclusion. We conclude that there is no prognostic effect of age at diagnosis of breast cancer among breast cancer patients treated at cancer centres in different parts of Iran; young and relatively old women have similar risks of dying from breast cancer.
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Rudat V, El-Sweilmeen H, Fadel E, Brune-Erber I, Ahmad Nour A, Bushnag Z, Masri N, Altuwaijri S. Age of 40 years or younger is an independent risk factor for locoregional failure in early breast cancer: a single-institutional analysis in saudi arabia. JOURNAL OF ONCOLOGY 2012; 2012:370385. [PMID: 22545048 PMCID: PMC3321571 DOI: 10.1155/2012/370385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 01/23/2012] [Accepted: 01/26/2012] [Indexed: 12/24/2022]
Abstract
Background. This study was undertaken to evaluate the impact of prognostic factors on the locoregional failure-free survival of early breast cancer patients. Methods. In this single-institutional study, 213 breast cancer patients were retrospectively analysed. Fifty-five of 213 patients were ≤40 years of age at diagnosis. The impact of patient- or treatment-related factors on the locoregional failure-free survival was assessed using the Kaplan-Meier method. The simultaneous impact of factors on the locoregional failure-free survival was assessed using the Cox proportional hazards regression analysis. Results. The median follow-up time of the censored patients was 22 months (mean 28 months, range 3-92 months). On univariate analysis, statistically significant factors for the locoregional failure-free survival were the age (≤40 versus >40 years), T stage (Tis, T0-2 versus T3-4), molecular tumor type (luminal A versus luminal B, Her2neu overexpression, or triple negative), and lymphovascular status (LV0 versus LV1). On multivariate analysis, age and T stage remained statistically significant. Conclusions. Being 40 years or younger has a statistically significant independent adverse impact on the locoregional failure-free survival of patients with early breast cancer.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Hamdan El-Sweilmeen
- Department of Haematology and Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Elias Fadel
- Department of Haematology and Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Iris Brune-Erber
- Department of Surgery, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Alaa Ahmad Nour
- Department of Radiation Oncology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Zinaida Bushnag
- Department of Surgery, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Nidal Masri
- Department of Pathology, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
| | - Saleh Altuwaijri
- SAAD Research & Development Center, Saad Specialist Hospital, P.O. Box 30353, Al Khobar 31952, Saudi Arabia
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Martinez-Ramos D, Escrig J, Torrella A, Hoashi JS, Alcalde M, Salvador JL. Risk of Recurrence of Non-Metastatic Breast Cancer in Women Under 40 Years: A Population-Registry Cancer Study in a European Country. Breast J 2012; 18:118-123. [DOI: 10.1111/j.1524-4741.2011.01208.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Peng R, Wang S, Shi Y, Liu D, Teng X, Qin T, Zeng Y, Yuan Z. Patients 35 years old or younger with operable breast cancer are more at risk for relapse and survival: A retrospective matched case–control study. Breast 2011; 20:568-73. [DOI: 10.1016/j.breast.2011.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/01/2011] [Accepted: 07/19/2011] [Indexed: 10/15/2022] Open
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Zidan J, Sikorsky N, Basher W, Sharabi A, Friedman E, Steiner M. Differences in pathological and clinical features of breast cancer in Arab as compared to Jewish women in Northern Israel. Int J Cancer 2011; 131:924-9. [DOI: 10.1002/ijc.26431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 08/22/2011] [Indexed: 11/06/2022]
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Tang J, Wu CC, Xie ZM, Luo RZ, Yang MT. Comparison of Clinical Features and Treatment Outcome of Breast Cancers in Young and Elderly Chinese Patients. ACTA ACUST UNITED AC 2011; 6:435-440. [PMID: 22419896 DOI: 10.1159/000332593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND: This study aimed to investigate the clinicopathological features and prognosis of operable breast cancers in young and elderly Chinese women. PATIENTS AND METHODS: This study included 209 patients aged ≤35 years and 213 patients aged ≥60 but <70 years, who received treatment between January 2000 and December 2004. The clinicopathological features, molecular subtypes, therapeutic strategies, and prognosis were evaluated. RESULTS: Tumor size was of significant difference between the 2 groups (p = 0.018), with more T2 and T3 tumors in the young group and more lymph node involvement in young patients with stage T1 tumors (p = 0.033). There were more triple-negative and less luminal A tumors in the young group (p = 0.018). 47.1% of tumors were not detected by mammography in the young group as compared to 5.5% in the elderly group (p < 0.001). More patients received chemotherapy in the young group (p < 0.001) and preferred breast-conserving surgery (p = 0.031). The 6-year disease-free survival (DFS) was 80 and 66% in the elderly and the young group, respectively (p = 0.001), but no difference was seen in overall survival. CONCLUSIONS: Compared with elderly women, young breast cancer patients have different clinicopathological features and molecular subtypes, and poorer DFS. Furthermore, the insidious onset of breast cancer in young women suggests that clinicians should pay more attention to young women with breast abnormalities.
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Affiliation(s)
- Jun Tang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, China
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Shen SC, Liao CH, Lo YF, Tsai HP, Kuo WL, Yu CC, Chao TC, Chen MF, Chang HK, Lin YC, Shen WC, Ueng SH, Lee LY, Hsueh S, Huang YT, Chen SC. Favorable outcome of secondary axillary dissection in breast cancer patients with axillary nodal relapse. Ann Surg Oncol 2011; 19:1122-8. [PMID: 21969085 DOI: 10.1245/s10434-011-2082-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Little evidence can be found about the long-term outcome of breast cancer patients after axillary lymph node recurrence (ALNR) and its survival benefit after different kinds of management. The present study intends to evaluate the risk factors associated with axillary recurrence after definite surgery for primary breast cancer. The prognosis after ALNR and particularly outcome of different management methods also were studied. METHODS We retrospectively reviewed data from 4,473 patients who were diagnosed with primary breast cancer and received surgical intervention in a single institute from January 1990 to December 2002. Medical files were reviewed and data on survival were updated annually. Risk factors and prognosis of patients with axillary recurrence were analyzed. Breast-cancer-specific survival of patients with ALNR and outcomes after different management methods also were studied. RESULTS After a median follow-up of 70.2 months, axillary recurrence developed in 0.8% of patients. Factors associated with ALNR included: age younger than 40 years, medial tumor location, no initial standard level I & II axillary dissection, and not receiving hormonal therapy. The 5-year breast-cancer-specific survival after ALNR was 57.9%. For patients who received further axillary dissection, the 5-year survival rate was 82.5% compared with 44.9% for patients who did not receive further dissection. CONCLUSIONS ALNR is a rare event in treating breast cancer. Young age at diagnosis and medially located tumor are associated with higher risk, but standardized initial axillary dissection to level II and adjuvant hormonal therapy is protective against ALNR. In patients with ALNR, the outcome is not dismal and survival may be improved if further axillary dissection is given.
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Affiliation(s)
- Shih-Che Shen
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan
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Clinicopathologic characteristics and prognosis of young patients with breast cancer. Breast 2011; 20:370-2. [DOI: 10.1016/j.breast.2011.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 10/14/2010] [Accepted: 02/02/2011] [Indexed: 11/23/2022] Open
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Pourzand A, Fakhree MBA, Hashemzadeh S, Halimi M, Daryani A. Hormone receptor status in breast cancer and its relation to age and other prognostic factors. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2011; 5:87-92. [PMID: 21695095 PMCID: PMC3117624 DOI: 10.4137/bcbcr.s7199] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increasing evidence shows the importance of young age, estrogen receptor (ER), progesterone receptor (PR) status, and HER-2 expression in patients with breast cancers. PATIENTS AND METHODS We organized an analytic cross-sectional study of 105 women diagnosed with breast cancer who have been operated on between 2008 to 2010. We evaluated age, size, hormone receptor status, HER-2 and P53 expression as possible indicator of lymph node involvement. RESULTS There is a direct correlation between positive progesterone receptor status and being younger than 40 (P < 0.05). Also, compared with older women, young women had tumors that were more likely to be large in size and have higher stages (P < 0.05). Furthermore patients with negative progesterone receptor status were more likely to have HER-2 overexpression (P < 0.05). The differences in propensity to lymph node metastasis between hormone receptor statuses were not statically significant. CONCLUSIONS Although negative progesterone receptor tumors were more likely to have HER-2 overexpression, it is possible that higher stage and larger size breast cancer in younger women is related to positive progesterone receptor status.
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Affiliation(s)
- Ali Pourzand
- Department of General Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Iran
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Brito C, Portela MC, Vasconcellos MTLD. Sobrevida de mulheres tratadas por câncer de mama no estado do Rio de Janeiro. Rev Saude Publica 2009; 43:481-9. [DOI: 10.1590/s0034-89102009000300012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 11/03/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a associação entre sobrevida de mulheres com câncer de mama e estrutura e práticas observadas nos estabelecimentos de assistência oncológica. MÉTODOS: Estudo longitudinal retrospectivo, baseado em informações do Sistema de Autorização de Procedimentos de Alta Complexidade do Sistema Único de Saúde e em amostra aleatória de 310 prontuários de mulheres prevalentes atendidas em 15 unidades hospitalares e ambulatoriais oncológicas com quimioterapia entre 1999 e 2002, no estado do Rio de Janeiro. Foram consideradas como variáveis independentes características da estrutura das unidades oncológicas e as suas intervenções praticadas, controlando o efeito com variáveis sociodemográficas e clínicas das pacientes. Para análise dos dados, foram utilizados a técnica de Kaplan-Meier e o modelo de risco de Cox (pseudo-verossimilhança). RESULTADOS: As análises de Kaplan-Meier apontaram associações significativas entre sobrevida e tempo entre diagnóstico e início do tratamento, realização de cirurgia, utilização de hormonioterapia, tipo de hormonioterapia, combinações terapêuticas, tipo de unidade e plano de saúde, volume de atendimento em câncer de mama do estabelecimento e natureza jurídica da unidade. Estimativas obtidas pelo modelo de Cox indicaram associações positivas entre o hazard de morte e tempo entre diagnóstico e início do tratamento, volume de atendimento de câncer de mama do estabelecimento e tipo de unidade combinado ao uso de plano de saúde; e negativas entre sobrevida e cirurgia de mama e tipo de hormonioterapia. CONCLUSÕES: Os resultados mostram associação entre sobrevida de câncer de mama e o cuidado de saúde prestado pelos serviços credenciados, com implicações práticas para pautar novas propostas para o controle do câncer no Brasil.
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Garicochea B, Morelle A, Andrighetti AE, Cancella A, Bós A, Werutsky G. [Age as a prognostic factor in early breast cancer]. Rev Saude Publica 2009; 43:311-7. [PMID: 19225690 DOI: 10.1590/s0034-89102009005000009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 09/05/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze age as a prognostic factor in early breast cancer. METHODS Retrospective study analyzing the clinical profile and disease-free survival in a group of 280 subjects aged 25 to 81 years with stage I and II breast cancer followed-up in Porto Alegre, southern Brazil, from 1995 to 2000. Clinical, pathological, treatment and outcome data were obtained from medical records. Subjects were divided into two groups according to age at diagnosis (< or = 40 years and > 40 years). The two groups were compared for clinical stage, histology, hormone receptor expression, therapy and radiotherapy using the chi-square and/or Fisher's exact test and for analysis of survival the Kaplan-Meier method with a long-rank test. RESULTS Of 280 women studied, 54 (19.3%) were younger than 40 years. Both groups were similar regarding clinical stage, histology, and hormone receptor expression. The proportion of subjects with disease-free survival in the 56-month follow-up was significantly higher in those over 40 years (84% versus 70%). Proportionally, younger subjects received more adjuvant therapy (88.8% vs. 77.8%). Those women over 40 years were significantly more likely to remain disease-free (84%), and this difference was more remarkable when they were compared to those over 40 years at stage I breast cancer. CONCLUSIONS The study findings confirm that women younger than 40 years with early breast cancer have a poorer prognosis. However, this prognosis does not seem to be related to increased number of hormone receptor-negative cases. Younger patients who remained disease-free received more adjuvant therapy, suggesting a positive effect of chemotherapy and endocrine therapy.
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Affiliation(s)
- Bernardo Garicochea
- Serviço de Oncologia Clínica, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Ou K, Yu K, Kesuma D, Hooi M, Huang N, Chen W, Lee SY, Goh XP, Tan LK, Liu J, Soon SY, Bin Abdul Rashid S, Putti TC, Jikuya H, Ichikawa T, Nishimura O, Salto-Tellez M, Tan P. Novel breast cancer biomarkers identified by integrative proteomic and gene expression mapping. J Proteome Res 2008; 7:1518-28. [PMID: 18318472 DOI: 10.1021/pr700820g] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Proteomic and transcriptomic platforms both play important roles in cancer research, with differing strengths and limitations. Here, we describe a proteo-transcriptomic integrative strategy for discovering novel cancer biomarkers, combining the direct visualization of differentially expressed proteins with the high-throughput scale of gene expression profiling. Using breast cancer as a case example, we generated comprehensive two-dimensional electrophoresis (2DE)/mass spectrometry (MS) proteomic maps of cancer (MCF-7 and HCC-38) and control (CCD-1059Sk) cell lines, identifying 1724 expressed protein spots representing 484 different protein species. The differentially expressed cell-line proteins were then mapped to mRNA transcript databases of cancer cell lines and primary breast tumors to identify candidate biomarkers that were concordantly expressed at the gene expression level. Of the top nine selected biomarker candidates, we reidentified ANX1, a protein previously reported to be differentially expressed in breast cancers and normal tissues, and validated three other novel candidates, CRAB, 6PGL, and CAZ2, as differentially expressed proteins by immunohistochemistry on breast tissue microarrays. In total, close to half (4/9) of our protein biomarker candidates were successfully validated. Our study thus illustrates how the systematic integration of proteomic and transcriptomic data from both cell line and primary tissue samples can prove advantageous for accelerating cancer biomarker discovery.
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Affiliation(s)
- Keli Ou
- Agenica Research Pte Ltd., National Cancer Centre of Singarope, and Genome Institute of Singapore, 11 Hospital Drive, Singapore 169610
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28
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Tan BK, Tan LK, Yu K, Tan PH, Lee M, Sii LH, Wong CY, Ho GH, Yeo AW, Chow PK, Koong HN, Yong WS, Lim DT, Ooi LL, Soo KC, Tan P. Clinical Validation of a Customized Multiple Signature Microarray for Breast Cancer. Clin Cancer Res 2008; 14:461-9. [DOI: 10.1158/1078-0432.ccr-07-0999] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
There is an urgent need to understand distant metastases in breast cancer as they are the most lethal form of recurrence and a major cause of mortality in patients. Some predictors for distant metastases, including nodal status, tumor grade, and hormonal status, are useful in identifying patients at increased risk for distant metastases. Adjuvant endocrine therapy has been the treatment of choice for postmenopausal women with hormone-sensitive breast cancer, and some therapies have shown significant reductions in the risk of distant metastases. Skeletal metastases in breast cancer are treated with bisphosphonates with a certain level of success. With more new agents undergoing clinical trials, a thorough review of the specific and long-term safety of these agents is essential, as is a better understanding of the deterioration in the quality of life and cost concerns of patients who develop distant metastases. Gene-expression profiling is a new entrant in the field of distant metastases diagnosis, which is largely successful in defining gene signatures that predict the development of distant metastases. This review will discuss the biology and the impact of distant metastases on outcomes for patients with breast cancer; it also encompasses the current status, emerging focus, and future perspectives in treatment of skeletal metastases in patients with breast cancer.
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Affiliation(s)
- Shafaat A Rabbani
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
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30
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Elkum N, Dermime S, Ajarim D, Al-Zahrani A, Alsayed A, Tulbah A, Al Malik O, Alshabanah M, Ezzat A, Al-Tweigeri T. Being 40 or younger is an independent risk factor for relapse in operable breast cancer patients: the Saudi Arabia experience. BMC Cancer 2007; 7:222. [PMID: 18053234 PMCID: PMC2222639 DOI: 10.1186/1471-2407-7-222] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 12/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer in young Saudi women is a crucial problem. According to the 2002 annual report of Saudi National Cancer Registry, breast cancers that developed before the age of 40 comprise 26.4% of all female breast cancers comparing to 6.5% in the USA. Breast cancer in young patients is often associated with a poorer prognosis, but there has been a scarcity of published data in the Middle East population. METHODS Total of 867 breast cancer patients seen at King Faisal Specialist Hospital & Research Centre (KFSH&RC) between 1986 and 2002 were reviewed. Patients were divided in two age groups: < or = 40 years and above 40 years. The clinicopathological characteristics and treatment outcomes were compared between younger and older age groups. RESULTS Median age at presentation was 45 years. A total of 288 (33.2%) patients were aged < or = 40 years. Hormone receptors were positive in 69% of patients 40 and 78.2% of patients above 40 (p = 0.009). There was a significantly higher incidence of grade III tumor in younger patients compared to older patients (p = 0.0006). Stage, tumor size, lymphatic/vascular invasion, number of nodes and axillary lymph node status, did not differ significantly between the two age groups. Younger patients had a greater probability of recurrence at all time periods (p = 0.035). Young age had a negative impact on survival of patients with positive axillary lymph nodes (p = 0.030) but not on survival of patients with negative lymph nodes (p = 0.695). Stage, tumor size, nodal status and hormonal receptors had negative impact on survival. Adjuvant chemotherapy was administered to 87.9% of younger and 65.6% of older patients (p < 0.0001). In terms of hormone therapy, the proportion of tamoxifen treated patients was significantly lower in young age group (p < 0.0001). No significant difference in radiation therapy between the two groups. CONCLUSION Young age (< or = 40) is an independent risk factor for relapse in operable Saudi breast cancer patients. The fundamental biology of young age breast cancer patients needs to be elucidated.
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Affiliation(s)
- Naser Elkum
- Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Saudi Arabia.
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31
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Affiliation(s)
- Stefan Aebi
- Department of Medical Oncology, University Hospital Inselspital, Bern, Switzerland.
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32
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El Saghir NS, Seoud M, Khalil MK, Charafeddine M, Salem ZK, Geara FB, Shamseddine AI. Effects of young age at presentation on survival in breast cancer. BMC Cancer 2006; 6:194. [PMID: 16857060 PMCID: PMC1555600 DOI: 10.1186/1471-2407-6-194] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 07/20/2006] [Indexed: 12/16/2022] Open
Abstract
Background Young age remains a controversial issue as a prognostic factor in breast cancer. Debate includes patients from different parts of the world. Almost 50% of patients with breast cancer seen at the American University of Beirut Medical Center (AUBMC) are below age 50. Methods We reviewed 1320 patients seen at AUBMC between 1990 and 2001. We divided them in three age groups: Below 35, 35–50, and above 50. Data and survival were analyzed using Chi-square, Cox regression analysis, and Kaplan Meier. Results Mean age at presentation was 50.8 years. 107 patients were below age 35, 526 between 35–50 and 687 patients above age 50. Disease stages were as follows: stage I: 14.4%, stage II: 59.9%, stage III: 20% and stage IV: 5.7%. Hormone receptors were positive in 71.8% of patients below 35, in 67.6% of patients 35–50 and in 78.3% of patients above 50. Grade of tumor was higher as age at presentation was lower. More young patients received anthracycline-based adjuvant chemotherapy. Of hormone receptor-positive patients, 83.8% of those below age 35 years, 87.76% of those aged 35–50 years, and 91.2% of those aged above 50 years received adjuvant tamoxifen. The mean follow up time was 3.7 +/- 2.9 years. Time to death was the only variable analyzed for survival analysis. Excluding stage IV patients, tumor size, lymph node, tumor grade and negative hormone receptors were inversely proportional to survival. Higher percentage of young patients at presentation developed metastasis (32.4% of patients below 35, as compared to 22.9% of patients 35–50 and 22.8% of patients above 50) and had a worse survival. Young age had a negative impact on survival of patients with positive axillary lymph nodes, and survival of patients with positive hormonal receptors, but not on survival of patients with negative lymph nodes, or patients with negative hormonal receptors. Conclusion Young age at presentation conferred a worse prognosis in spite of a higher than expected positive hormone receptor status, more anthracycline-based adjuvant chemotherapy and equivalent adjuvant tamoxifen hormonal therapy in younger patients. This negative impact on survival was seen in patients with positive lymph nodes and those with positive hormonal receptors.
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Affiliation(s)
- Nagi S El Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Department of Obstetrics & Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen K Khalil
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad K Salem
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady B Geara
- Radiation Oncology of the American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali I Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Rapiti E, Fioretta G, Verkooijen HM, Vlastos G, Schäfer P, Sappino AP, Kurtz J, Neyroud-Caspar I, Bouchardy C. Survival of young and older breast cancer patients in Geneva from 1990 to 2001. Eur J Cancer 2005; 41:1446-52. [PMID: 15919199 DOI: 10.1016/j.ejca.2005.02.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 01/27/2005] [Accepted: 02/03/2005] [Indexed: 12/01/2022]
Abstract
The effect of age on breast cancer survival is still a matter of controversy. Breast cancer in young women is thought to be more aggressive and to have worse prognosis but results from clinical research have been neither consistent nor definitive. In this study, we have assessed the impact of young age at diagnosis on tumor characteristics, treatment and survival of breast cancer. The study included 82 very young (< or = 35 years), 790 young (36-49), and 2125 older (50-69) women recorded between 1990 and 2001 at the Geneva Cancer Registry. Very young and young patients had more often stage II cancers (P = 0.009), poorly differentiated (P < 0.001) and estrogen receptor negative (P < 0.001) tumors. They were also more likely to receive chemotherapy (P < 0.001) and less likely to receive hormonal therapy (P < 0.001). Specific five-year survival was not different in the three groups (91%, 90%, and 89% for very young, young and older, respectively). When adjusting for all prognostic variables, age was not significantly related to mortality from breast cancer with a hazard ratio of 0.8 (95% CI: 0.3-2.0) for very young and 1.1 (95% CI: 0.8-1.4) for young patients compared to older women. Tumor stage, differentiation, estrogen receptor status, surgery, and radiotherapy were all independent determinants of breast cancer prognosis. We conclude that age is not an independent prognostic factor when accounting for breast tumor characteristics and treatment.
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Affiliation(s)
- Elisabetta Rapiti
- Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, Switzerland
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