不同年龄女性乳腺癌患者的临床特征及预后分析

目的分析不同年龄段女性乳腺癌患者的5年净生存率以及发病年龄与乳腺癌死亡风险的关系。方法回顾性收集2006—2010年北京市4所医院北京户籍的乳腺癌患者首诊病例资料。共纳入浸润性、原发性女性乳腺癌患者3470例,随访截至2018年12月31日,获取全部患者的生存信息。采用寿命表法分析各年龄组乳腺癌患者的5年净生存率,采用Cox比例风险模型分析不同年龄组乳腺癌患者发生乳腺癌死亡的风险,采用限制性立方样条模型分析发病年龄与乳腺癌死亡风险之间的剂量反应关系。结果3470例女性乳腺癌患者的平均年龄为53.2岁,其中45~54岁年龄组发病人数最多(1289例),占37.15%;<35岁年龄组发病人数最少(126例),仅占3.63%。随访期间,死于乳腺癌的患者528例(15.22%),乳腺癌5年净生存率为90.72%(95%CI为89.74%~91.70%);<35岁和≥65岁乳腺癌患者的5年净生存率较低,分别为88.68%(95%CI为83.09%~94.27%)和87.05%(95%CI为84.27%~89.82%)。控制潜在的混杂因素后,以乳腺癌发病年龄为45~54岁为参照,<35岁和≥65岁年龄组发生死亡的HR分别为1.72(95%CI为1.06~2.81)和1.89(95%CI为1.43~2.49),且在Luminal A和Luminal B分子分型中,≥65岁患者具有更高的乳腺癌死亡风险(Luminal A型:HR=1.70,95%CI为1.17~2.46;Luminal B型:HR=3.84,95%CI为1.74~8.49)。限制性立方样条模型分析结果显示,乳腺癌发病年龄与乳腺癌死亡风险的关联呈现非线性的J形剂量反应关系(非线性检验P<0.0001)。结论年龄为影响乳腺癌患者预后的独立因素,年轻和老年乳腺癌患者的预后均较差。

Clinical features and prognostic analysis of female breast cancer in different diagnosed ages

Objective To evaluate 5-years breast cancer-specific survival(CCS)by age,and the relationship of age at diagnosis and the risk of breast cancer mortality.Methods Medical records of 3470 resident patients diagnosed with primary,invasive female breast cancer between January 1,2006 and December 31,2010 in four hospitals in Beijing were reviewed and collected.All patients were followed up until December 31,2018 to acquire survival outcome.Five-years breast CCS of the five subgroups was estimated by the life-table method.Cox proportional hazard regression models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)of different levels of age stratification and breast cancer mortality,and restricted cubic spline(RCS)model was used to detect the dose-response relationship.Results The median diagnosis age among 3470 female breast cancer patients was 53.2 years.There were 1289 patients in the age-group of 45~54 years,with the highest proportion of 37.15%.However,only 126 patients occurred in the age-group of less than 35 years,with the lowest proportion of 3.63%.A total of 528(15.22%)patients died of breast cancer during the study period.Overall 5-year CCS was 90.72%(95%CI:89.74%~91.70%),88.68%(95%CI:83.09%~94.27%)and 87.05%(95%CI:84.27%~89.82%)for all of the patients,aged less than 35 years and those aged 65 years and older.Compared with patients with diagnosis age of 45~54 years,the multivariate-adjusted HRs for breast cancer mortality associated with patients in age-group of<35 years and those in the age-group of≥65 years were 1.72(95%CI:1.06~2.81)and 1.89(95%CI:1.43~2.49),respectively.In addition,patients aged≥65 years had significantly higher risk of breast cancer mortality in Luminal subtypes,with HR of 1.70(95%CI:1.17~2.46)for Luminal A breast cancer and HR of 3.84(95%CI:1.74~8.49)for Luminal B breast cancer.RCS analysis exhibited a non-linear("J-shaped")relationship between diagnosis age of female breast cancer and the risk of breast cancer mortality(nonlinear P<0.0001).In addition,patients aged≥65 years had significantly higher risk of breast cancer mortality in Luminal subtypes,with HR of 1.70(95%CI:1.17~2.46)for Luminal A breast cancer and HR of 3.84(95%CI:1.74~8.49)for Luminal B breast cancer.RCS analysis exhibited a non-linear("J-shaped")relationship between diagnosis age of female breast cancer and the risk of breast cancer mortality(nonlinear P<0.0001).Conclusion Age at diagnosis is an important prognostic factor for female breast cancer,with worse outcome for both young and old patients.