确诊时年轻与乳腺癌生存的亚型相关性

　　年轻女性发展为更有侵袭性乳腺癌亚型的风险增加。虽然既往研究表明早期乳腺癌年轻女性乳腺癌复发和死亡的风险较高，但是未能充分阐明肿瘤亚型对结局的影响。

　　2016年8月1日，美国临床肿瘤学会官方期刊《临床肿瘤学杂志》在线发表达纳-法伯癌症研究所、布莱根女子医院、哈佛大学陈曾熙公共卫生学院、希望之城综合癌症中心、斯坦福大学癌症研究所、福克斯切斯癌症中心、孟菲斯浸信会癌症中心、德克萨斯大学MD安德森癌症中心的研究报告，分析了确诊时年轻与乳腺癌生存的亚型相关性。

　　该研究调查了2000年1月～2007年12月提交给国家综合癌症网络（NCCN）8个中心之一的新确诊I～III期乳腺癌女性数据，采用多变量Cox比例风险模型评定了年龄与乳腺癌特异性生存之间的相关性。

　　结果共有17575位I～III期乳腺癌女性符合条件进行分析，其中1916位确诊时年龄≤40岁，中位随访时间为6.4年。

　　在排除社会统计学、疾病和治疗特征影响的多变量Cox比例风险模型中，女性确诊时年龄≤40岁的乳腺癌死亡率较高（风险比：1.4，95%置信区间：1.2～1.7）。

　　在分层分析中，年龄≤40岁女性乳腺癌死亡风险统计学显著增加有相关性的肿瘤亚型包括管腔A型（风险比：2.1，95%置信区间：1.4～3.2）和管腔B型（风险比：1.4，95%置信区间：1.1～1.9），三阴性（风险比：1.4，95%置信区间：1.0～1.8）有临界显著相关性，但是与HER2亚型相关性不显著（风险比：1.2，95%置信区间：0.8～1.9）。

　　此外，在排除检测方法影响的模型中，年轻女性乳腺癌死亡风险显著增加仅与管腔A型肿瘤有关。

　　因此，年龄对早期乳腺癌女性生存的影响，似乎取决于不同的乳腺癌亚型。年轻的管腔型乳腺癌女性似乎预后特殊。

J Clin Oncol. 2016 Augl 1. [Epub ahead of print]

Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival.

Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Rebecca A. Ottesen, Yu-Ning Wong, Stephen B. Edge, Richard L. Theriault, Douglas W. Blayney, Joyce C. Niland, Eric P. Winer, Jane C. Weeks, Rulla M. Tamimi.

Dana-Farber Cancer Institute and Brigham and Women's Hospital; Harvard T.H. Chan School of Public Health, Boston, MA; City of Hope Comprehensive Cancer Center, Duarte; Stanford Cancer Institute, Palo Alto, CA; Fox Chase Cancer Center, Philadelphia, PA; Baptist Cancer Center, Memphis, TN; The University of Texas MD Anderson Cancer Center, Houston, TX.

PURPOSE: Young women are at increased risk for developing more aggressive subtypes of breast cancer. Although previous studies have shown a higher risk of breast cancer recurrence and death among young women with early-stage breast cancer, they have not adequately addressed the role of tumor subtype in outcomes.

METHODS: We examined data from women with newly diagnosed stage I to III breast cancer presenting to one of eight National Comprehensive Cancer Network centers between January 2000 and December 2007. Multivariable Cox proportional hazards models were used to assess the relationship between age and breast cancer-specific survival.

RESULTS: A total of 17,575 women with stage I to III breast cancer were eligible for analysis, among whom 1,916 were ≤ 40 years of age at diagnosis. Median follow-up time was 6.4 years. In a multivariable Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women ≤ 40 years of age at diagnosis had greater breast cancer mortality (hazard ratio [HR], 1.4; 95% CI, 1.2 to 1.7). In stratified analyses, age ≤ 40 years was associated with statistically significant increases in risk of breast cancer death among women with luminal A (HR, 2.1; 95% CI, 1.4 to 3.2) and luminal B (HR, 1.4; 95% CI, 1.1 to 1.9) tumors, with borderline significance among women with triple-negative tumors (HR, 1.4; 95% CI, 1.0 to 1.8) but not among those with human epidermal growth factor receptor 2 subtypes (HR, 1.2; 95% CI, 0.8 to 1.9). In an additional model controlling for detection method, young age was associated with significantly increased risk of breast cancer death only among women with luminal A tumors.

CONCLUSION: The effect of age on survival of women with early breast cancer seems to vary by breast cancer subtype. Young age seems to be particularly prognostic in women with luminal breast cancers.

DOI: 10.1200/JCO.2015.65.8013