Laura Sabiani1, Gilles Houvenaeghel2, Mellie Heinemann2, Fabien Reyal3, Jean Marc Classe4, Monique Cohen5, Jean Rémy Garbay6, Sylvia Giard7, Hélène Charitansky8, Nicolas Chopin9, Roman Rouzier10, Emile Daraï11, Charles Coutant12, Pierre Azuar13, Pierre Gimbergues14, Richard Villet15, Christine Tunon de Lara16, Eric Lambaudie2. 1. Aix-Marseille University, Marseille, France; Department of Surgical Oncology, Institute Paoli-Calmettes, Marseille, France. Electronic address: laurasabiani@hotmail.com. 2. Aix-Marseille University, Marseille, France; Department of Surgical Oncology, Institute Paoli-Calmettes, Marseille, France. 3. Department of Surgical Oncology, Curie Institute, Paris, France. 4. Department of Surgical Oncology, West Cancer Institute, Nantes, France. 5. Department of Surgical Oncology, Institute Paoli-Calmettes, Marseille, France; Department of Surgical Oncology, Casamance Hospital, Aubagne, France. 6. Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France. 7. Department of Surgical Oncology, Oscar Lambret Centre, Lille, France. 8. Department of Surgical Oncology, Claudius Regaud Institute, Toulouse, France. 9. Department of Surgical Oncology, Léon Bérard Centre, Lyon, France. 10. Department of Surgical Oncology, René Huguenin Centre, Saint-Cloud, France. 11. Department of Surgical Oncology, Tenon Hospital, Paris, France. 12. Department of Surgical Oncology, Georges-François Leclerc Centre, Dijon, France. 13. Department of Surgical Oncology, Grasse Hospital, Grasse, France. 14. Department of Surgical Oncology, Jean Perrin Centre, Clermont-Ferrand, France. 15. Deaconess Hospital, Paris, France. 16. Department of Surgical Oncology, Bergonié Institute, Bordeaux, France.
Abstract
PURPOSE: Controversy exists about the prognosis of breast cancer in young women. Our objective was to describe clinicopathological and prognostic features to improve adjuvant treatment indications. METHODS: We conducted a retrospective multi centre study including fifteen French hospitals. Disease-free survival's data, clinical and pathological criteria were collected. RESULTS: 5815 patients were included, 15.6% of them where between 35 and 40 years old and 8.7% below 35. In 94% of the cases, a palpable masse was found in patients ≤35 years old. Triple negative and HER2 tumors were predominantly found in patients ≤35 (22.2% and 22.1%, p < 0.01). A young age ≤40 years (p < 0.001; hazard ratio [HR]: 2.05; 95% confidence limit [CL]: 1.60-2.63) or ≤35 years (p < 0.001; [HR]: 3.86; 95% [CL]: 2.69-5.53) impacted on the indication of chemotherapy. Age ≤35 (p < 0.001; [HR]: 2.01; 95% [CL]: 1.36-2.95) was a significantly negative factor on disease-free survival. Chemotherapy (p < 0.006; [HR]: 0.6; 95% [CL]: 0.40-0.86) and positive hormone receptor status (p < 0.001; [HR]: 0.6; 95% [CL]: 0.54-0.79) appeared to be protector factors. Patients under 36, had a significantly higher rate of local recurrence and distant metastasis compared to patients >35-40 (21.5 vs. 15.4% and 21.8 vs. 12.6%, p < 0.01). CONCLUSION: Young women present a different distribution of molecular phenotypes with more luminal B and triple negative tumors with a higher grade and more lymph node involvement. A young age, must be taken as a pejorative prognostic factor and must play a part in indication of adjuvant therapy.
PURPOSE: Controversy exists about the prognosis of breast cancer in young women. Our objective was to describe clinicopathological and prognostic features to improve adjuvant treatment indications. METHODS: We conducted a retrospective multi centre study including fifteen French hospitals. Disease-free survival's data, clinical and pathological criteria were collected. RESULTS: 5815 patients were included, 15.6% of them where between 35 and 40 years old and 8.7% below 35. In 94% of the cases, a palpable masse was found in patients ≤35 years old. Triple negative and HER2 tumors were predominantly found in patients ≤35 (22.2% and 22.1%, p < 0.01). A young age ≤40 years (p < 0.001; hazard ratio [HR]: 2.05; 95% confidence limit [CL]: 1.60-2.63) or ≤35 years (p < 0.001; [HR]: 3.86; 95% [CL]: 2.69-5.53) impacted on the indication of chemotherapy. Age ≤35 (p < 0.001; [HR]: 2.01; 95% [CL]: 1.36-2.95) was a significantly negative factor on disease-free survival. Chemotherapy (p < 0.006; [HR]: 0.6; 95% [CL]: 0.40-0.86) and positive hormone receptor status (p < 0.001; [HR]: 0.6; 95% [CL]: 0.54-0.79) appeared to be protector factors. Patients under 36, had a significantly higher rate of local recurrence and distant metastasis compared to patients >35-40 (21.5 vs. 15.4% and 21.8 vs. 12.6%, p < 0.01). CONCLUSION: Young women present a different distribution of molecular phenotypes with more luminal B and triple negative tumors with a higher grade and more lymph node involvement. A young age, must be taken as a pejorative prognostic factor and must play a part in indication of adjuvant therapy.
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