AGE AS PROGNOSTIC FACTOR IN PREMENOPAUSAL BREAST-CARCINOMA
AGE AS PROGNOSTIC FACTOR IN PREMENOPAUSAL BREAST-CARCINOMA
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DOI：
10.1016/0140-6736(93)92407-k
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发表时间：
1993-04-24
期刊：
影响因子：
168.9
通讯作者：
FOURQUET, A
中科院分区：
文献类型：
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作者：
DELAROCHEFORDIERE, A;ASSELAIN, B;FOURQUET, A
诊断年龄小是否是乳腺癌的不良预后因素一直存在争议，部分原因是许多先前的工作没有适当考虑到绝经状态和混杂因素。我们分析了年龄对连续1703例I-III期乳腺癌患者预后的影响。所有患者均为绝经前患者，并于1981年至1985年间在一个中心（巴黎居里研究所）接受治疗。平均年龄44岁（23-55岁），中位随访82个月。与老年患者相比，年轻患者的生存率明显较低，局部和远处复发率较高。在最年轻的年龄组（小于或等于33岁）中，复发的危险率随着时间的推移而下降，5年后达到老年患者的危险率。复发风险与年龄之间的关系是连续的，最佳拟合为对数线性函数，表明每一岁的复发率下降4%。生存率和无病间期的多变量分析表明，年轻时较差的预后与临床肿瘤大小、临床淋巴结状态、组织学分级、激素受体状态、局部治疗方式和辅助全身治疗等其他因素无关。这种观点上的差异还没有得到生物学上的解释，但它确实表明有必要更仔细地研究年轻女性乳腺癌的自然历史。
Whether or not young age at diagnosis is an adverse prognostic factor in breast cancer has long been controversial, in part because much previous work has not taken due account of menopausal status and confounding factors. We have analysed the influence of age on prognosis in a consecutive series of 1703 patients with stage I-III breast cancer. All were premenopausal and all were treated in one centre (Institut Curie, Paris) between 1981 and 1985. Mean age was 44 years (range 23-55) and median follow-up was 82 months.Younger patients had significantly lower survival rates and higher local and distant relapse rates than older patients. The hazard rate of relapse decreased over time in the youngest age group (less-than-or-equal-to 33) to reach that of older patients after 5 years. The relation between the hazard of recurrence and age was a continuous one, best fitted by a log-linear function and indicating a 4% decrease in recurrence for every year of age. Multivariate analysis of both survival and disease-free interval demonstrated that the worse prognosis of young age was independent of other factors such as clinical tumour size, clinical node status, histological grade, hormone receptor status, locoregional treatment procedure, and adjuvant systemic therapy.This difference in outlook has yet to be explained biologically but it does suggest the need for a closer look at the natural history of breast cancer in young women.