Otuz yaş altı meme kanserli kadınların klinikopatolojik özellikleri ve sağkalım sonuçları

Öz

Amaç: Bu çalışmanın amacı 30 yaş ve altı meme kanserli hastaların klinikopatolojik özelliklerini ve prognostik faktörlerini değerlendirmektir. Gereç ve yöntemler: Kliniğimizde tedavi gören 30 yaş ve altı meme kanserli hastaları retrospektif olarak inceledik. Hastaların özellikleri, patolojik verileri ve sağ kalımı dosyalardan kayıt edildi. Bulgular: Toplam 50 hasta kaydedildi. Tanı anında 5 (%10) hastada metastatik hastalık, 2 (%4) hastada gebelik, 5 (%10) hastada emzirme durumu vardı ve ortanca yaş 28 (20-30) idi. Vakaların %88'inde ilk başvuru şikayeti palpe edilebilen bir kitleydi. İnvaziv duktal karsinom, vakaların % 86'sında saptanan histolojik tipti. Luminal A, moleküler alt tip %44 hasta vardı. Metastatik olmayan 44 hastada medyan takip süresi 59.9 aydı ve 5 yıllık hastalıksız sağ kalım (DFS) ve genel sağ kalım (OS) sırasıyla %61.4 ve %95.5 idi. Metastatik olmayan hastaların takibinde 5 (%11.4) hasta öldü, 3 (%6.8) hastada lokal nüks gelişti ve 17 (%38.7) hastada uzak metastaz gelişti. Metastazlar esas olarak karaciğerde, ardından akciğerler ve kemiklerde meydana geldi. Cox regresyon analizlerinde, adjuvan radyoterapinin DFS'nin olumlu bir prediktörü olduğunu bulduk Sonuç: Otuz yaş ve altı kadınlarda meme kanseri, daha yüksek üçlü negatif ve HER2 benzeri alt tip oranları ile ilişkiliydi. Ayrıca, bu hastalar, genç kadınlar için önceki çalışmalarda bildirilenden daha iyi 5 yıllık OS oranına sahipti ve adjuvan radyoterapi DFS'nin bağımsız bir prognostik faktörüydü

Anahtar Kelimeler

• meme kanseri
• genç kadın
• prognoz

Clinicopathological features and survival outcomes of very young women (aged 30 and under ) with breast cancer

Abstract

Aim: The aim of this study was to evaluate clinicopathological characteristics and prognostic factors of patients with breast cancer (BC) aged 30 and under. Materials and methods: We retrospectively analyzed BC patients aged 30 and under who were treated our oncology department. Patients characteristics, pathologic and treatment related data, pattern of relapse and survival were collected from hospital files. Results: A total of 50 patients were enrolled. At diagnosis, 5 (10%) patients had metastatic disease, 2 (4%) patients had pregnancy, 5 (10%) patients had breastfeeding, and the median age was 28 (20-30) years. The patients had pathological features, including node-positivity (66%), grade 2 (50%), lymphovascular invasion (LVI) (38%) and perineural invasion (PNI) (26%). Luminal A was the predominant molecular subtype (44%). Twelve percent of the patients had HER2-like and 16% had triple negative diseases. In 45 non-metastatic patients, the median follow-up was 59.9 months, and 5-year disease-free survival (DFS) and overall survival (OS) were 61.4% and 95.5%, respectively. During follow-up of non-metastatic patients, 5 (11.4%) patients were died, 3 (6.8%) patients developed local recurrence, and 17 (38.7%) patients developed distant metastatic disease. In Cox regression analyses, we found that adjuvant radiotherapy was a favorable predictor of DFS. Conclusions: Breast cancer in women aged 30 and under years was associated with higher triple negative and HER2-like subtypes rates. Also, these patients had better 5-year OS rate than reported in previous studies for young women, and adjuvant radiotherapy was an independent prognostic factors of DFS.

Keywords

• Breast cancer
• young women
• prognosis

References

1. 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30. doi: 10.3322/caac.21590.
2. 2. Franzoi MA, Rosa DD, Zaffaroni F, Werutsky G, Simon S, Bines J, et al. Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115). J Glob Oncol. 2019 Nov;5:1-10. doi: 10.1200/JGO.19.00263.
3. 3. Paluch-Shimon S, Pagani O, Partridge AH, Abulkhair O, Cardoso MJ, Dent RA, et al. ESO-ESMO 3rd international consensus guidelines for breast cancer in young women (BCY3). Breast. 2017 Oct;35:203-17. doi: 10.1016/j.breast.2017.07.017.
4. 4. DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017 Nov;67(6):439-48. doi: 10.3322/caac.21412.
5. 5. Abdel-Razeq H, Almasri H, Abdel Rahman F, Abdulelah H, Abu Nasser M, Salam M, et al. Clinicopathological Characteristics And Treatment Outcomes Of Breast Cancer Among Adolescents And Young Adults In A Developing Country. Cancer Manag Res. 2019 Nov 22;11:9891-7. doi: 10.2147/CMAR.S229337. eCollection 2019.
6. 6. Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol. 2008 Jul 10;26(20):3324-30. doi: 10.1200/JCO.2007.14.2471. Erratum in: J Clin Oncol. 2011 Sep 20;29(27):3721.
7. 7. Erić I, Petek Erić A, Kristek J, Koprivčić I, Babić M. Breast Cancer In Young Women: Pathologıc And Immunohıstochemıcal Features. Acta Clin Croat. 2018 Sep;57(3):497-502. doi: 10.20471/acc.2018.57.03.13.
8. 8. Bertheau P, Steinberg SM, Cowan K, Merino MJ. Breast cancer in young women: clinicopathologic correlation. Semin Diagn Pathol. 1999 Aug;16(3):248-56.

9. 9. Johansson ALV, Andersson TM, Hsieh CC, Jirström K, Cnattingius S, Fredriksson I, et al. Tumor characteristics and prognosis in women with pregnancy-associated breast cancer. Int J Cancer. 2018 Apr 1;142(7):1343-54. doi: 10.1002/ijc.31174.
10. 10. Bae SY, Kim SJ, Lee J, Lee ES, Kim EK, Park HY, et al. Clinical subtypes and prognosis of pregnancy-associated breast cancer: results from the Korean Breast Cancer Society Registry database. Breast Cancer Res Treat. 2018 Nov;172(1):113-21. doi: 10.1007/s10549-018-4908-6.
11. 11. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002 Oct 17;347(16):1233-41.
12. 12. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al; Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17;366(9503):2087-106. Review.
13. 13. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011 Nov 12;378(9804):1707-16. doi:10.1016/S0140-6736(11)61629-2. Epub 2011 Oct 19. Review.
14. 14. Lazow SP, Riba L, Alapati A, James TA. Comparison of breast-conserving therapy vs mastectomy in women under age 40: National trends and potential survival implications. Breast J. 2019 Jul;25(4):578-584. doi: 10.1111/tbj.13293. Epub 2019 May 14.
15. 15. Vaz-Luis I, Hughes ME, Cronin A, Rugo HS, Edge SB, Moy B, et al. Trends in the use of mastectomy in women with small node-negative breast cancer treated at US academic centers. Breast Cancer Res Treat. 2016 Feb;155(3):569-78. doi: 10.1007/s10549-016-3707-1. Epub 2016 Feb 11.
16. 16. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015 Jan;150(1):9-16. doi:10.1001/jamasurg.2014.2895.
17. 17. Ye JC, Yan W, Christos PJ, Nori D, Ravi A. Equivalent Survival With Mastectomy or Breast-conserving Surgery Plus Radiation in Young Women Aged < 40 Years With Early-Stage Breast Cancer: A National Registry-based Stage-by-Stage Comparison. Clin Breast Cancer. 2015 Oct;15(5):390-7. doi: 10.1016/j.clbc.2015.03.012. Epub 2015 Apr 2.
18. 18. Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast. 2015 Jun;24(3):175-81. doi: 10.1016/j.breast.2015.02.002. Epub 2015 Feb 23. Review.
19. 19. Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA Jr, Bianchi-Micheli G, et al. ESO-ESMO 4(rd) International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol. 2020 Mar 18. pii: S0923-7534(20)36363-8. doi: 10.1016/j.annonc.2020.03.284.
20. 20. Francis PA, Pagani O, Fleming GF, Walley BA, Colleoni M, Láng I, et al; SOFT and TEXT Investigators and the International Breast Cancer Study Group. Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer. N Engl J Med. 2018 Jul 12;379(2):122-37. doi: 10.1056/NEJMoa1803164.
21. 21. Bonnier P, Romain S, Charpin C, Lejeune C, Tubiana N, Martin PM, et al. Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer. 1995 Jul 17;62(2):138-44.
22. 22. Xiong Q, Valero V, Kau V, Kau SW, Taylor S, Smith TL, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M.D. Anderson Cancer Center experience. Cancer. 2001 Nov 15;92(10):2523-8.
23. 23. American Cancer Society: Breast Cancer Facts & Figures 2013-2014. Atlanta, GA, American Cancer Society, 2013.
24. 24. Thomas A, Rhoads A, Pinkerton E, Schroeder MC, Conway KM, Hundley WG, et al. Incidence and Survival Among Young Women With Stage I-III Breast Cancer: SEER 2000-2015. JNCI Cancer Spectr. 2019 Jun 7;3(3):pkz040. doi: 10.1093/jncics/pkz040. eCollection 2019 Sep.
25. 25. Partridge AH, Hughes ME, Warner ET, Ottesen RA, Wong YN, Edge SB, et al. Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival. J Clin Oncol. 2016 Sep 20;34(27):3308-14. doi: 10.1200/JCO.2015.65.8013.
26. 26. Dai D, Zhong Y, Wang Z, Yousafzai NA, Jin H, Wang X. The prognostic impact of age in different molecular subtypes of breast cancer: a population-based study. PeerJ. 2019 Jul 4;7:e7252. doi: 10.7717/peerj.7252. eCollection 2019.
27. 27. Thomas A, Rhoads A, Suhl J, Conway KM, Hundley WG, McNally LR, et al. Incidence and Survival by Human Epidermal Growth Factor Receptor 2 Status in Young Women With Stage I-III Breast Cancer: SEER, 2010-2016. Clin Breast Cancer. 2020 Feb 4. pii: S1526-8209(20)30030-6. doi: 10.1016/j.clbc.2020.01.014.
28. 28. Zimmer AS, Zhu K, Steeg PS, Wu A, Gatti-Mays ME, Soltani S, et al. Analysis of breast cancer in young women in the Department of Defense (DOD) database. Breast Cancer Res Treat. 2018 Apr;168(2):501-11. doi: 10.1007/s10549-017-4615-8.