35岁及以下年轻乳腺癌患者的临床资料分析

摘要

目的：分析35岁及以下年轻乳腺癌患者的临床病理特征、生存情况及影响预后的因素。方法回顾性分析天津医科大学肿瘤医院2008年1月—12月收治的105例治疗规范的年龄≤35岁年轻乳腺癌患者（年轻组）的临床及病理资料，并与同年收治的103例治疗规范的65~70岁老年乳腺癌患者（老年组）进行比较，并对患者的预后情况进行随访。结果年轻组随访期间有25例（23.8%）出现局部复发或转移，17例（16.2%）死亡；老年组有8例（7.8%）出现局部复发或转移，9例（8.7%）死亡。与老年组相比，年轻组初诊时原发肿瘤直径大，组织学分级高，P53突变率较高（均P＜0.05）。年轻组5年无病生存率低于老年组（76.2%vs.92.2%，Log-rankχ2=9.799，P=0.002），5年总生存率与老年组差异无统计学意义（83.8%vs.91.3%，Log-rankχ2=2.758，P=0.097）。Cox多因素分析结果显示，肿瘤直径、是否有腋窝淋巴结转移是影响年轻组乳腺癌患者5年无病生存率的独立预后因素，而P53阳性与否和是否有腋窝淋巴结转移是影响年轻组乳腺癌5年总生存率的独立预后因素。结论年轻乳腺癌患者的生物学行为恶性程度更高，预后更差。因此，对乳腺癌高风险年轻女性需采用针对性的预防筛查策略，制定个体化治疗方案。%Objective To analyze the clinical and pathological characteristics and prognosis of breast cancer in women aged 35 years and younger. Methods The clinical data of 105 breast cancer patients (≤35 years) who received comprehensive standardized treatment in our hospital in 2008 were retrospectively analyzed. And the clinical data of 103 breast cancer patients aged 65-70 years treated in our hospital during the same year were chosen as control group. Results During the follow-up period, local recurrence and metastasis were found in 25 patients (23.8%), and dead in 17 cases (16.2%) in young group. In elderly group, local recurrence or metastasis were found in 8 patients (16.2%) and dead in 9 cases (8.7%). Compared with elderly group, the primary tumor diameter was large, the histological grade was high and the mutation rate of P53 was higher in the younger group (P < 0.05). The 5-year disease-free survival rate was lower in the young group than that of the elderly group (76.2% vs. 92.2%, Log-rank χ2=9.799,P=0.002). There was no significant difference in the 5-year overall survival rate between the two groups (83.8%vs. 91.3%, Log-rankχ2=2.758, P=0.097). Cox multivariate analysis showed that tumor diameter and axillary lymph node metastasis were independent prognostic factors influencing 5-year disease-free survival rate in young group. The positive expression of P53 and axillary lymph node metastasis were independent prognostic factors influencing 5-year overall survival rate in young group. Conclusion Our study indicates that the histological grade of breast cancer is higher and the prognosis is even worse in young patients. Therefore, young women with the high risk of breast cancer need to be targeted for prevention and screening strategies to develop individualized treatment programs.