| Purpose:We aimed to study the proportion of fertility in young women with breast cancer after treatment and compared the clinicopathological features and prognosis between patients who became pregnant and non-pregnant in the study.Meanwhile we analyze the disease free survival(DFS)of patients within 5 years after surgery to become pregnant compared with their control group and the safety of interrupting endocrine therapy(30 months ν>30 months)among pregnant patients with hormone receptor positive.Method:A retrospective study in which women with breast cancer under the age of 35 were analyzed in the Tianjin Medical University Cancer Institute and Hospital from January 1,2006 to December 31,2014.There were 1108 young patients diagnosed with breast cancer undergoing surgery during the period.According to the inclusion and exclusion criteria,774 cases were included eventually in our study.The pregnant group were matched(1:4)to non-pregnant patients with similar tumor size,lymph node metastasis,estrogen/progesterone receptor status,molecular subtypes and years of diagnosis.At last,68 pregnant patients and matched 264 non-pregnant patients were enrolled in the study and we compared the clinicopathological features and prognosis between the two groups.Analyses were conducted using SPSS 22.0 and P values <0.05 were considered statistical significant.Results:1、A total of 1108 cases of young breast cancer treated by surgery were included in the study between 2006-2014.The median age of the whole group was32(5-35)years,the very young breast cancer patients aged ≤25 years old accounted for 6.5%,74.5% of patients were stage I and II breast cancer at the time of diagnose,the 5-year disease-free survival rate was 90.3%,and the 5-year overall survival rate was 92.0%.Of these,68 patients became completely pregnant after operation,accounting for 6.1%.2、Age distribution of pregnant patients were 21 to 34 years,the median agewas 28 years,The first pregnant rates after surgery among the groups of age ≤25years,26 to 30 years and 31 to 35 years old were 93.3%,89.5% and 46.7%,respectively.3、There were 68(20.5%)cases of complete pregnancy and 264(79.5%)cases matched patients without pregnancy.The median age of the patients who became pregnant were younger than that of non-pregnant patients(median age,28 v 33 years;p < 0.001),and it was more likely that there was no procreation or lactation before the operation in pregnant group(80.9%v16.7%,82.4%v24.6%;respectively;p<0.001).In comparison with the patients who did not become subsequently pregnant,the pregnant patients were observed with significantly improved rates of undergoing breast-conserving surgery(44.1%v24.6%;p=0.002).The ratio of neo-adjuvant chemotherapy(20.6%v7.2%;p=0.001)and post-operative radiotherapy(55.9%v37.5%;p=0.012)in pregnant group was higher than that of the control group.4、There were 35 patients relapsed during the subsequent follow-up,including 3cases in the pregnant group,32 in the non-pregnant group.No one was found died by the end of the follow-up in the pregnant group,while 7 died in the control group.No statistically significant differences were found in DFS and OS between the two groups(DFS:p=0.058,OS:p=0.152;).5、A total of 206 young breast cancer patients had Hormone receptor(HR)positive,43 in the pregnant group and 163 in the non-pregnant group.We did not find any statistically significant difference in DFS and OS between pregnant group with hormone receptor(HR)positive and their matched group(DFS:p=0.657,OS:p=0.250).Regarding the HR-negative patients,there was no difference in OS between pregnant group and the control group(p=0.389).Nevertheless,the pregnant group showed a better DFS than the matched group(p=0.026).6、There were 30 patients who became pregnant within 5 years after operation and 119 matched patients without pregnancy.There were 1 recurrence in pregnant group and 22 recurrence in control group within 5 years after operation.A better DFS was found in patients with pregnancy interval ≤ 5 years after surgery and their control group(p =0.042).7、Among the 68 patients who became pregnant,43 cases had HR-positive and41 were treated with adjuvant endocrine therapy after operation.There were 11(25.6%)patients whose duration of endocrine therapy was less than or equal to 30 months,of whom 2 patients relapsed including one had bone metastasis and the other one local lymph node recurrence after operation.and the other 32(74.4%)patients with endocrine therapy more than 30 months after surgery,one of them had bone metastasis.A statistically significant difference was observed in DFS for women whose duration of endocrine therapy more than or less than 30 months in the pregnant group(p= 0.01)that more than 30 months’ endocrine therapy had a better outcome.Conclusion:Women diagnosed with breast cancer aged 35 after treatment showed a lower fertility rate.Most of the young patients who gave birth after operation were younger and had no childbearing history before the disease,and were more likely to have undergone breast-conserving surgery than the ones who did not pregnant,what’s more,the ratio of neo-adjuvant chemotherapy and post-operative radiotherapy was significantly higher than that of the control group.There is no difference in prognosis between pregnant patients and non-pregnant patients,even if young breast cancer patients with HR-positive did not show a worse prognosis,and such these patients have a better DFS after the duration of endocrine therapy >30 months than that of ≤30 months.In addition,our retrospective investigation demonstrated a better DFS in women who became pregnant within five years compared to women who did not become pregnant. |
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