Loco-regional recurrence trend and prognosis in young women with breast cancer according to molecular subtypes: analysis of 1099 cases

Abstract

Background The number of young patients diagnosed with breast cancer is on the rise. We studied the rate trend of local recurrence (LR) and regional recurrence (RR) in young breast cancer (YBC) patients and outcomes among these patients based on molecular subtypes. Methods A retrospective cohort study was conducted based on data from Tianjin Medical University Cancer Institute and Hospital for patients ≤ 35 years of age with pathologically confirmed primary invasive breast cancer surgically treated between 2006 and 2014. Patients were categorized according to molecular subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year rates for LR, RR, and distant metastases (DM) were estimated by Kaplan-Meir statistics. Nelson-Aalen cumulative-hazard plots were used to describe local recurrence- and distant metastasis-free intervals. Results We identified 25,284 patients with a median follow-up of 82 months, of whom 1099 (4.3%) were YBC patients ≤ 35 years of age. The overall 5-year LR, RR, and DM rates in YBC patients were 6.7%, 5.1%, and 16.6%, respectively. The LR and RR rates demonstrated a decreasing trend over time (P = 0.028 and P = 0.015, respectively). We found that early-stage breast cancer and less lymph node metastases increased over time (P = 0.004 and P = 0.007, respectively). Patients with HR−/HER2+ status had a significantly higher LR (HR 20.4; 95% CI, 11.8–35.4) and DM (HR 37.2; 95% CI, 24.6–56.3) at 10 years. Breast-conserving surgery (BCS) or mastectomy did not influence rates of LR and RR. In the overall population, the 5-year survival of YBC patients exceeded 90%. Conclusions The rates of LR and RR with YBC patients demonstrated a downward trend and the proportion of early-stage breast cancer increased between 2006 and 2014. We report the highest LR rates in this young population were associated with HR−/HER2+ tumors.

Assessing Tumor-Infiltrating Lymphocytes in Breast Cancer: A Proposal for Combining Immunohistochemistry and Gene Expression Analysis to Refine Scoring

“…Globally, breast cancer is the most frequently diagnosed cancer and a major cause of death in women worldwide (1). Recurrence of breast cancer cells occurs in a significant number of patients with a recent meta-analysis showing that the overall 5-year rates for distant metastasis, regional recurrence, and local recurrence in <35-year-old breast cancer patients were 16.6%, 5.1%, and 6.7%, respectively (2). Currently, tumor-node-metastasis staging is implemented to stratify patients; yet, patients within the same stage still can show a different clinical outcome.…”

Association of Preoperative Serum Levels of CEA and CA15-3 with Molecular Subtypes of Breast Cancer

“…Similarly, molecular subtypes along with the four immunohistochemical factors are employed as a guide for targeted treatment, including hormonal therapy, anti-Her2 agent, and cytotoxic therapy [ 8 , 10 , 11 ]. Moreover, differences in prognosis among different subtypes of breast cancer also existed [ 12 – 14 ].…”

Impact of the ACOSOG Z0011 trial on surgical practice in Asian patients: trends in axillary surgery for breast cancer from a Korean Breast Cancer Registry analysis

“…Furthermore, our study demonstrated that patients with TNBC or HER2-positive subtype who met the Z0011 criteria received more ALND than those with other subtypes. As TNBC or HER2-positive tumors are strong predictors of disease recurrence, a more aggressive surgical management for axilla seems to have been carried out [ 27 , 28 ].…”