54例25岁以下女性乳腺癌的临床特征和预后分析

The clinical characteristics and prognostic factors of breast carcinoma in women aged 25 years or less

背景与目的:25岁以下女性乳腺癌非常少见,目前缺乏这部分患者的预后报道,对其生物学特点和临床特征认识亦非常有限。本研究回顾性分析肿瘤研究所收治的年轻乳腺癌患者的临床表现和病理学特点和影响预后的因素。方法:收集1980年1月—2005年12月收治的54例25岁以下女性乳腺癌患者的临床资料,观察长期生存率,分析其临床特点及影响预后的因素。结果:54例患者占同期收治乳腺癌的0.48%,其中浸润性导管癌42例(77.8%),均无乳腺癌及卵巢癌家族史。Ⅰ、Ⅱ期患者占68.5%,淋巴结转移率为53.7%,肿瘤大小T1、T2占79.6%。根据生物学特点,ER和PR的阳性率较低(分别为29.6%和36.0%),HER-2阳性率较高(22.2%)。有8例患者存在脉管瘤栓。38例患者接受辅助化疗。化疗可以明显改善淋巴结阳性患者的5年总生存率(OS)(P=0.007)。有26例患者死亡。5年无病生存率(DFS)和OS分别为54.3%和55.5%。诊断延迟3个月以上(P=0.019)、临床分期(P=0.000)、肿瘤大小(P=0.007)、腋淋巴结转移(P=0.000)及脉管瘤栓(P=0.011)是预后相关的因素。多因素分析显示诊断延迟3个月以上(P=0.034)和淋巴结转移(P=0.027)是独立预后因素。结论:25岁以下女性浸润性乳腺癌有更强的侵袭性。诊断延迟3个月以上和淋巴结转移是不良预后因素。青少年和极年轻乳腺癌患者的治疗原则与一般乳腺癌相同,但是需要探索更为合理的个体化综合治疗。

Background and purpose： Breast cancer is a rare disease in women aged less than 25.Furthermore, there were fewer studies reporting the outcomes of this cohort and the knowledge regarding its biological characteristics and clinical features were limited. The aim of this retrospective study was to examine and audit the experience of our institution in treating the extremely young patients with breast cancer, to focus on the clinical presentation and pathological findings, and to identify the prognostic factors which might be helpful in identifying those patients with a worse prognosis. Methods： From Jan 1980 to Dec 2005, there were 54 breast carcinoma patients in women aged 25 years or less treated in our hospital.We retrospectively analyzed their clinical, histological and treatment variables as well as 5-year overall survival （OS） and 5-year disease-free survival （DFS）. Results： There were 0.48% of all breast cancer cases who occurred in age of 25 or less in our institute in the period. We found 77.8% to be invasive ductal carcinoma and none of the patients had any family history of breast cancer or ovarian cancer. Clinically, 68.5% were stage Ⅰ or Ⅱ, 53.7% had lymph node metastasis. 79.6% were classified as T1 or T2. Regarding the biological features, the frequencies of positive ER and PR were low （29.6%, 36.0%, respectively）, and the frequency of positive c-erbB2 （22.2%） was higher. Lymphovascular invasion occurred in eight patients. Thirty-eight patients received adjuvant chemotherapy. 26 patients in this study died of breast cancer. The 5-year DFS and OS were 54.3% and 55.5%, respectively. In lymph node-positive patients, chemotherapy improved their 5-year OS significantly （P=0.007）. The patients who might have a worse prognosis were usually with diagnostic delay more than 3 months （P=0.019）, higher clinical stage （P=0.000）, larger tumor size （P=0.007）, lymph node-positive （P=0.000） and lymphovascular invasion （P=0.011）. Multivariate analysis revealed that both diagnostic delay more than 3 months and lymph node-positive were the independent prognostic factors （P=0.034,P=-0.027, respectively）. Conclusion： Breast cancer is a rare condition in women aged 25 or less. Invasive breast cancer occurring at this subgroup has more aggressive biological behaviors. Diagnostic delay of more than 3 months and lymph node metastasis are considered adverse prognostic factors in the current study. The general principles of managing adolescents and very young women with breast cancer are no different to those applying to older women in current study, but development of tailored treatment for this population is still crucial.