Young Age Is Associated with Increased Locoregional Recurrence in Node-Positive Breast Cancer with Luminal Subtypes
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose The effects of biological subtypes within breast cancer on prognosis are influenced by age at diagnosis. We investigated the association of young age with locoregional recurrence (LRR) between patients with luminal subtypes versus those with nonluminal subtypes. Materials and Methods Medical records of 524 breast cancer patients with positive lymph nodes between 1999 and 2010 were reviewed retrospectively. All patients received curative surgery and adjuvant chemotherapy based on contemporary guidelines. Radiation was delivered for patients who underwent breast conserving surgery or those who had four or more positive lymph nodes after mastectomy. Adjuvant hormone therapy was administered to 413 patients with positive hormone receptors according to their menstrual status. Results During median follow-up of 84 months, the 10-year locoregional recurrence-free survival rate (LRRFS) was 84.3% for all patients. Patients < 40 years showed significantly worse 10-year LRRFS than those 40 years (73.2% vs. 89.0%, respectively; p=0.01). The negative effect of young age on LRRFS was only observed in luminal subtypes (69.7% for < 40 years vs. 90.8% for 40 years; p < 0.01). Multivariate analysis using luminal subtypes 40 years as a reference revealed luminal subtypes < 40 years were significantly associated with increased risk of LRR (hazard ratio, 2.33; p < 0.01). Conclusion Young breast cancer patients with positive lymph nodes had a higher risk of LRR than those aged 40 years. This detrimental effect of young age on LRR was confined in luminal subtypes.
Abstract
Purpose The effects of biological subtypes within breast cancer on prognosis are influenced by age at diagnosis. We investigated the association of young age with locoregional recurrence (LRR) between patients with luminal subtypes versus those with nonluminal subtypes. Materials and Methods Medical records of 524 breast cancer patients with positive lymph nodes between 1999 and 2010 were reviewed retrospectively. All patients received curative surgery and adjuvant chemotherapy based on contemporary guidelines. Radiation was delivered for patients who underwent breast conserving surgery or those who had four or more positive lymph nodes after mastectomy. Adjuvant hormone therapy was administered to 413 patients with positive hormone receptors according to their menstrual status. Results During median follow-up of 84 months, the 10-year locoregional recurrence-free survival rate (LRRFS) was 84.3% for all patients. Patients < 40 years showed significantly worse 10-year LRRFS than those 40 years (73.2% vs. 89.0%, respectively; p=0.01). The negative effect of young age on LRRFS was only observed in luminal subtypes (69.7% for < 40 years vs. 90.8% for 40 years; p < 0.01). Multivariate analysis using luminal subtypes 40 years as a reference revealed luminal subtypes < 40 years were significantly associated with increased risk of LRR (hazard ratio, 2.33; p < 0.01). Conclusion Young breast cancer patients with positive lymph nodes had a higher risk of LRR than those aged 40 years. This detrimental effect of young age on LRR was confined in luminal subtypes.
참고문헌 (30)
- Perou CM, "Molecular portraits of human breast tumours", Nature, 406, pp.747~752 (2000)
- Sorlie T, "Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications", Proc Natl Acad Sci U S A, 98, pp.10869~10874 (2001)
- Brenton JD, "Molecular classification and molecular forecasting of breast cancer: ready for clinical application?", J Clin Oncol, 23, pp.7350~7360 (2005)
- Nielsen TO, "Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma", Clin Cancer Res, 10, pp.5367~5374 (2004)
- Carey LA, "Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study", JAMA, 295, pp.2492~2502 (2006)
- Haffty BG, "Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer", J Clin Oncol, 24, pp.5652~5657 (2006)
- Kyndi M, "Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in highrisk breast cancer : the Danish Breast Cancer Cooperative Group", J Clin Oncol, 26, pp.1419~1426 (2008)
- Nguyen PL, "Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy", J Clin Oncol, 26, pp.2373~2378 (2008)
- Millar EK, "Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel", J Clin Oncol, 27, pp.4701~4708 (2009)
- Voduc KD, "Breast cancer subtypes and the risk of local and regional relapse", J Clin Oncol, 28, pp.1684~1691 (2010)
- Gabos Z, "The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer", Breast Cancer Res Treat, 124, pp.187~194 (2010)
- Arvold ND, "Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy", J Clin Oncol, 29, pp.3885~3891 (2011)
- Metzger-Filho O, "Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease : results from international breast cancer study group trials VIII and IX", J Clin Oncol, 31, pp.3083~3090 (2013)
- Adami HO, "The relation between survival and age at diagnosis in breast cancer", N Engl J Med, 315, pp.559~563 (1986)
- Anders CK, "Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression", J Clin Oncol, 26, pp.3324~3330 (2008)
- Ahn SH, "Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance : nationwide survival data in Korea : a report from the Korean Breast Cancer Society", J Clin Oncol, 25, pp.2360~2368 (2007)
- Cancello G, "Prognosis and adjuvant treatment effects in selected breast cancer subtypes of very young women(< 35 years)with operable breast cancer", Ann Oncol, 21, pp.1974~1981 (2010)
- Kim HJ, "Young age is associated with ipsilateral breast tumor recurrence after breast conserving surgery and radiation therapy in patients with HER2-positive", ER-negative subtype, 2011, pp.130, 499~505
- Kim EK, "Prognostic significance of young age(< 35 years)by subtype based on ER, PR, and HER2 status in breast cancer : a nationwide registry-based study", World J Surg, 35, pp.1244~1253 (2011)
- Park YH, "Prevalence and clinical outcomes of young breast cancer(YBC)patients according to intrinsic breast cancer subtypes : Single institutional experience in Korea", Breast, 24, pp.213~217 (2015)
- Albain KS, "Breast cancer outcome and predictors of outcome: are there age differentials?", J Natl Cancer Inst Monogr, 16, pp.35~42 (1994)
- Colleoni M, "Role of endocrine responsiveness and adjuvant therapy in very young women(below 35 years)with operable breast cancer and node negative disease", Ann Oncol, 17, pp.1497~1503 (2006)
- Davies C, "Long-term effects of continuing adjuvant tamoxifen to 10years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer : ATLAS, a randomised trial", Lancet, 381, pp.805~816 (2013)
- Cheang MC, "Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer", J Natl Cancer Inst, 101, pp.736~750 (2009)
- Kim J, "The value of Ki67 in very young women with hormone receptor-positive breast cancer : retrospective analysis of 9, 321Korean women", Ann Surg Oncol, 22, pp.3481~3488 (2015)
- Goldhirsch A, "Strategies for subtypes: dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011", Ann Oncol, 22, pp.1736~1747 (2011)
- Sheridan W, "Breast cancer in young women: have the prognostic implications of breast cancer subtypes changed over time", Breast Cancer Res Treat, 147, pp.617~629 (2014)
- Liedtke C, "The prognostic impact of age in patients with triple-negative breast cancer", Breast Cancer Res Treat, 138, pp.591~599 (2013)
- Han W, "Young age : an independent risk factor for disease-free survival in women with operable breast cancer", BMC Cancer, 4, pp.82~ (2004)
- Cheang MC, "Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype", Clin Cancer Res, 14, pp.1368~1376 (2008)