|
虽然单侧乳腺癌女性的预防性对侧乳房切除术不断增加，但是生存改善的证据尚不明确，故有必要了解对侧乳腺癌的风险因素，以减少过度治疗。 2018年10月30日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表韩国釜山东南放射医学研究所、蔚山大学首尔峨山医院、东国大学一山医院的研究报告，调查了对侧乳腺癌的年龄相关风险因素。 该研究纳入1989～2008年诊断为非转移性单侧浸润性乳腺癌患者8716例，其中年轻组年龄<35岁患者652例、年长组年龄≥35岁女性2608例。根据个体匹配的原发肿瘤大小、淋巴结转移、分级和亚型数据，对年轻组与年长组之间的原发肿瘤和治疗差异进行校正。按不同年龄分析对侧乳腺癌风险因素、无对侧乳腺癌生存、每年对侧乳腺癌风险。 结果，发生对侧乳腺癌的中位时间为6.1年。年轻组与年长组相比，对侧乳腺癌检出率分别为6.6%比2.5%。 多因素分析表明：
年轻女性对侧乳腺癌高发峰值时间：
因此，该研究结果表明，校正原发乳腺肿瘤特征后，35岁以下患者与年长女性相比，对侧乳腺癌发病风险高达2.5倍。对于HER2阳性亚型、激素受体阳性亚型的年轻女性，原发乳腺癌后分别于5年内、5年后达到对侧乳腺癌高发峰值时间。 Breast Cancer Res Treat. 2018 Oct 30. [Epub ahead of print] Age-related risk factors associated with primary contralateral breast cancer among younger women versus older women. Tae In Yoon, Beom Seok Kwak, On Vox Yi, Seonok Kim, Eunhae Um, Keong Won Yun, Hae-na Shin, SaeByul Lee, Guiyun Sohn, Il Yong Chung, Jisun Kim, Beom Seok Ko, Jong Won Lee, Byung Ho Son, Sei Hyun Ahn, Hee Jeong Kim. Dongnam Institute of Radiological and Medical Science, Busan, Korea; University of Ulsan, Asan Medical Center, Seoul, Korea; Dongguk University Ilsan Hospital, Goyang-si, Korea. PURPOSE: Contralateral prophylactic mastectomy is increasing, despite unclear evidence of improving survival. To investigate the age-related risk factors for contralateral breast cancer (CBC). METHODS: This study included 8716 patients diagnosed with non-metastatic unilateral invasive breast cancer between 1989 and 2008. Data on primary tumor size, node metastasis, grade and subtype using individual matching were used to adjust for differences in the primary tumor and treatment between younger and older age groups. CBC risk factors, CBC-free survival, and annual CBC risk were analyzed by age. RESULTS: The younger group included 652 patients aged under 35 years, and the older group included 2608 women aged 35 years or older. The median time to CBC development was 6.1 years. CBC was detected in 6.6% of the women in the younger group and 2.5% of those in the older group. Multivariable analysis revealed a relative CBC risk of 2.48 in younger women compared to older women. The risk was significantly higher among women with human epidermal growth factor receptor 2 (HER2)-overexpressing tumors (hazard ratio [HR] 4.98), a family history of breast cancer (HR 7.79), and anti-hormone therapy (HR 3.46). In younger women with HER2-positive cancer, CBC occurrence peaked at 4.6 years after surgery, in those with hormone receptor-positive cancer, it peaked at 7.1 years after surgery, and in triple-negative disease cases, and it increased steadily over time. CONCLUSIONS: After adjusting for primary breast tumor characteristics, patients <35 years old had 2.5 times the risk of CBC development compared to the older women. CBC occurrence peaked within 5 years after primary breast cancer in younger women with the HER2-positive subtype and after 5 years in cases with the hormone receptor-positive subtype. KEYWORDS: Young breast cancer Contralateral breast cancer HER2/neu Metachronous DOI: 10.1007/s10549-018-5031-4
|
|
|
