湖南省单中心518例年轻乳腺癌临床病理学特征分析

Analysis of clinicopathologic characteristics of 518 young breast cancer patients from a single center in Hunan

背景与目的:乳腺癌在所有女性恶性肿瘤中发病率排名首位,且年轻乳腺癌预后相对较差。年轻女性乳腺癌患者由于要面临特有的身体、社会心理、家庭等问题,更应受到关注。本研究通过分析湖南省单中心518例年轻女性乳腺癌患者的相关数据探讨年轻女性乳腺癌患者的临床病理学特点,以期为优化该类患者的治疗提供依据。方法:回顾性分析中南大学湘雅医院乳腺科2002年1月—2018年4月行手术治疗的518例年龄≤35岁的年轻女性乳腺癌患者资料,另选同期收治的年龄≥65岁的老年女性乳腺癌患者435例作为对照,比较两组患者临床及病理资料的差异。此外,将518例年轻乳腺癌患者的分子分型分布与以往在不同乳腺癌人群中的研究结果进行比较。结果:518例年轻乳腺癌患者中,31~35岁年龄段占69.5%;正常BMI(18.5~<25 kg/m^2)占74.5%;未生育者18.2%;3.3%有乳腺癌家族史;63.7%曾行新辅助化疗;77.0%行改良根治术;57.0%为TNM II期;53.7%无淋巴结转移;80.5%为非特殊类型浸润性导管癌;分子分型以luminal型为主,其中luminal A型占37.6%,luminal B型占29.2%。与老年乳腺癌患者比较,年轻乳腺癌患者的分子分型分布无统计学差异(P>0.05);正常BMI患者比增高(74.5%vs.60.9%);Ⅲ~Ⅳ期比例增高(25.5%vs.20.5%);无淋巴结转移的比例明显降低(53.7%vs.66.2%);保乳手术率及含重建手术的比例均增高(9.3%vs.3.2%;7.5%vs.1.8%),差异均有统计学意义(均P<0.05)。518例年轻乳腺癌患者的分子分型分布与笔者以往两项湖南乳腺癌整体人群研究的分子分型分布均有明显差异(均P=0.000),但与国内广东以及美国年轻乳腺癌人群研究的分子分型分布相似(均P>0.05);前者的差异估计与检测方法及分型标准的变化有关。结论:相对于老年女性乳腺癌患者,年轻女性乳腺癌患者疾病进展快,容易发生淋巴结转移,对保乳手术与乳房重建的需求较高。因此,积极进行乳腺癌筛查,提高早期检出率仍至关重要,同时应进一步提高保乳率、不断发展乳房重建与生育保存技术。

Background and Aims:The incidence rate of breast cancer ranks first among all female malignant tumors,and the prognosis of breast cancer in young women is relatively poor.Young women with breast cancer require special attention because they often face unique physical,psychosocial and emotional issues.This study was conducted to investigate the clinicopathologic characteristics of breast cancer in young adults by analyzing the relevant data of 518 young breast cancer women from a single center in Hunan,so as to provide evidence for optimizing the treatment for this group of patients.Methods:The records of 518 women aged≤35 years with breast cancer undergoing surgical treatment in the Department of Breast Surgery of Xiangya Hospital,Central South University from January 2002 to April 2018 were retrospectively analyzed,and 435 women aged≥65 year with breast cancer treated during the same period were served as control.The differences in clinical and pathologic features between the two groups of patients were compared.Furthermore,the distribution of molecular subtypes of the 518 patients were compared with those from previous studies in different breast cancer populations.Results:Among the 518 young breast cancer women,the proportion of cases with age from 31 to 35 accounted for 69.5%,with a normal BMI(18.5–<25 kg/m^2)accounted for 74.5%,18.2%were nullipara,3.3%had a family history of breast cancer,63.7%underwent neoadjuvant chemotherapy,77.03%were subjected to the modified radical mastectomy,57.0%had a stage TNM Ⅱ disease,53.7%were found no lymph node metastasis,80.5%were invasive ductal carcinomas of no special type,and luminal cancer was the main molecular subtype,with luminal A type accounting for 37.6%and luminal B type accounting for 29.2%.In young breast cancer women versus older breast cancer women,the distribution of molecular subtypes showed no significant difference(P>0.05),the proportion of cases with normal BMI was higher(74.5%vs.60.9%),the proportion of cases with stage Ⅲ~Ⅳ disease was higher(25.5%vs.20.5%),the proportion of cases without lymph node metastasis was lower(53.7%vs.66.2%),both breastconserving surgery rate and proportion of cases with synchronous reconstructive surgery were higher(9.3%vs.3.2%;7.5%vs.1.8%),and all the differences had statistical significance(all P<0.05).The distribution of molecular subtypes of the 518 patients were significantly different with those from the authors’previous studies in the overall breast cancer population in Hunan province(both P=0.000),but was similar with those from studies in young breast cancer population in China’s Guangdong province and America(both P>0.05),and the differences occurred in the former was considered due to the changes in detection method and subtyping criteria.Conclusion:Compared with elderly breast cancer women,young breast cancer women have a relatively rapid disease progression,are more likely to develop lymph node metastasis,and have higher requirements for breast-conserving surgery and breast reconstruction.Therefore,aggressive breast cancer screening to improve the early detection rates is still of great importance.Meanwhile,the breast-conserving rate should be further increased,and the breast reconstruction and fertility preservation technologies should be continuously developed.