The clinical characteristics and prognostic factors of breast carcinoma in women aged 25 years or less / 中国癌症杂志

ABSTRACT

Background and purpose:Breast cancer is a rare disease in women aged less than 25.Furthermore,there were fewer studies reporting the outcomes of this cohort and the knowledge regarding its biological characteristics and clinical features were limited. The aim of this retrospective study was to examine and audit the experience of our institution in treating the extremely young patients with breast cancer,to focus on the clinical presentation and pathological fi ndings,and to identify the prognostic factors which might be helpful in identifying those patients with a worse prognosis. Methods:From Jan 1980 to Dec 2005,there were 54 breast carcinoma patients in women aged 25 years or less treated in our hospital.We retrospectively analyzed their clinical,histological and treatment variables as well as 5-year overall survival(OS) and 5-year disease-free survival(DFS) . Results:There were 0.48% of all breast cancer cases who occurred in age of 25 or less in our institute in the period. We found 77.8% to be invasive ductal carcinoma and none of the patients had any family history of breast cancer or ovarian cancer. Clinically,68.5% were stage Ⅰ or Ⅱ,53.7% had lymph node metastasis. 79.6% were classifi ed as T1 or T2. Regarding the biological features,the frequencies of positive ER and PR were low(29.6%,36.0%,respectively) ,and the frequency of positive c-erbB2(22.2%) was higher. Lymphovascular invasion occurred in eight patients. Thirty-eight patients received adjuvant chemotherapy. 26 patients in this study died of breast cancer. The 5-year DFS and OS were 54.3% and 55.5%,respectively. In lymph node-positive patients,chemotherapy improved their 5-year OS signifi cantly(P=0.007) . The patients who might have a worse prognosis were usually with diagnostic delay more than 3 months(P=0.019) ,higherclinical stage(P=0.000) ,larger tumor size(P=0.007) ,lymph node-positive(P=0.000) and lymphovascular invasion(P=0.011) . Multivariate’ analysis revealed that both diagnostic delay more than 3 months and lymph node-positive were the independent prognostic factors(P=0.034,P=0.027,respectively) . Conclusion:Breast cancer is a rare condition in women aged 25 or less. Invasive breast cancer occurring at this subgroup has more aggressive biological behaviors. Diagnostic delay of more than 3 months and lymph node metastasis are considered adverse prognostic factors in the current study. The general principles of managing adolescents and very young women with breast cancer are no different to those applying to older women in current study,but development of tailored treatment for this population is still crucial.