Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort
Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort
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DOI：
10.1002/ijc.31950
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发表时间：
2019-03-15
影响因子：
6.4
通讯作者：
Ursin, Giske
中科院分区：
文献类型：
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作者：
Johansson, Anna L. V.;Trewin, Cassia B.;Ursin, Giske
年龄和肿瘤亚型是影响乳腺癌生存的预后因素，但目前尚不清楚哪个更重要。我们使用基于人口的数据来解决这个问题。2005年至2015年间，我们在挪威癌症登记处发现了21,384名年龄在20-89岁之间被诊断患有乳腺癌的女性。根据雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子2 （HER2）的状态来定义亚型为腔内a样（ER+PR+HER2-）、腔内b样HER2阴性（ER+PR+/-HER2+）、腔内b样HER2阳性（ER+PR+/-HER2+）、HER2阳性（ER-PR-HER2+）和三阴性（TNBC） （ER-PR-HER2-）。Cox回归根据年龄和亚型估计乳腺癌特异性7年生存率的风险比（HR），同时根据年份、分级、TNM分期和治疗进行调整。年轻女性多为her2阳性和TNBC肿瘤，而老年女性（70-89）多为腔内a样肿瘤。与50-59岁的女性相比，年轻女性的乳腺癌特异性死亡率增加了一倍（HR = 2.26, 95% CI 1.81-2.82），而老年人的死亡率则高出2至5倍（70-79岁：HR = 2.25, 1.87-2.71； 80-89岁：HR = 5.19, 4.21-6.41）。调整后，这种关联在年轻女性中不显著，但在老年女性中仍然很高。在腔内a样亚型中，年轻与乳腺癌特异性死亡率增加有关，而老年与所有亚型的死亡率增加有关。年龄和亚型是较强的独立预后因素。老年人总是表现较差，调整后也为亚型。肿瘤相关因素（亚型、分级和分期）在很大程度上解释了年轻人中较高的乳腺癌特异性死亡率。未来的研究应该解决为什么腔内a样亚型与年轻女性较高的死亡率相关。
Age and tumor subtype are prognostic factors for breast cancer survival, but it is unclear which matters the most. We used population-based data to address this question. We identified 21,384 women diagnosed with breast cancer at ages 20-89 between 2005 and 2015 in the Cancer Registry of Norway. Subtype was defined using estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) status as luminal A-like (ER+PR+HER2-), luminal B-like HER2-negative (ER+PR-HER2-), luminal B-like HER2-positive (ER+PR+/-HER2+), HER2-positive (ER-PR-HER2+) and triple-negative (TNBC) (ER-PR-HER2-). Cox regression estimated hazard ratios (HR) for breast cancer-specific 7-year survival by age and subtype, while adjusting for year, grade, TNM stage and treatment. Young women more often had HER2-positive and TNBC tumors, while elderly women (70-89) more often had luminal A-like tumors. Compared to age 50-59, young women had doubled breast cancer-specific mortality rate (HR = 2.26, 95% CI 1.81-2.82), while elderly had two to five times higher mortality rate (70-79: HR = 2.25, 1.87-2.71; 80-89: HR = 5.19, 4.21-6.41). After adjustments, the association was non-significant among young women but remained high among elderly. Young age was associated with increased breast cancer-specific mortality among luminal A-like subtype, while old age was associated with increased mortality in all subtypes. Age and subtype were strong independent prognostic factors. The elderly always did worse, also after adjustment for subtype. Tumor-associated factors (subtype, grade and stage) largely explained the higher breast cancer-specific mortality among young. Future studies should address why luminal A-like subtype is associated with a higher mortality rate in young women.