| Background and Objective:Breast cancers are the most common malignancies among Chinese women.In recent years,the incidence rate is increasingand the age of onset of this disease is becoming younger.breast malignancies in patients aged ?35 years are more aggressive and have a poorer prognosis.At present,there are few studies on the clinical epidemiology of Chinese breast cancer patients aged ? 35 years.Clinicians and patients lack the necessary reference when choosing among prevention measures and treatment strategies.In recent years,people have focused on gene therapy with good specificity,clear action sites,strong action force and low toxicity.But many genes involved in breast cancer are currently under study,and the key genes that actually cause breast cancer have not yet been identified.Recently,multiple investigations have established correlation between FAS(Fas cell surface deathreceptor)single nucleotide polymorphisms(SNPs)and breast carcinoma susceptibility in Asia.However,the conclusions of these reports are inconsistent,with significant regional differences.This study aims to analyze the clinical epidemiological characteristics,survival and prognostic factors of female breast cancer patients aged ? 35 years,and a meta-analysis of published studies was performed to derive a more precise assessment of the association between breast cancersusceptibility with FAS gene promoter(-1377G/A and-670A/G)SNPs.We are to provide a scientific basis for the prevention clinical diagnosisand individualized therapy of breast cancer.Methods This research includes two parts:In part one,analyzed the clinical data of 130 female breast cancer patients aged ?35years who were treated in the Department of Breat Surgery of the First Affiliated Hospital of Anhui Medical University from January 2008 to December 2013.The clinical data analyzed included general characteristics,clinical pathological characteristics and treatment.We explore the relationship between these factors.The prognosis of the patients was followed up,andthe prognostic factors affecting thepatients' 5-year overall survival(OS)and the 5-year disease free survival(DFS)were analyzed.In part two,We systematically searched Pub Med,Embase,Web of Science and the Chinese biomedical database(CBM)for papers published until November 1,2018.All meet the requirements of the retrieved documents were confirmed,review and review types of literature outside the scope of research.Statistical analysis was conducted using Stata13.0 software.Odds ratio(OR)with 95% confidential interval(95%CI)was conducted to evaluate the associationsbetween breast cancer susceptibility with FAS gene promoter SNPs.Publication bias was also evaluated and sensitivity analysis was performed.A total of eight studies covering 2,564 cases and 2,633 controls were included.ResultsIn part one,a total of 130 female breast cancer patients aged ?35 years were included in the study,with an average age of 31 years.Tumors were mainly detected in theupper outer quadrant of their left breast(62.3%).Molecular subtyping suggested that58.4% of the patients had Luminal B breast cancer.Pathological analysis revealed that84.6% of the patients had invasive ductal carcinoma of the breast.In terms of treatment,66.9% of the patients underwent modified radical mastectomy.Patients with invasive ductal carcinoma had a higher incidence(51.8%)of lymph node metastasis than those with ductal carcinoma-in-situ(6.3%)and other breast carcinomas(50%)(p=0.001).There was a statistically significant association between the primary tumor location and the incidence of lymph node metastasis.Patients with tumors in their upper outer quadrant of the breast had the highest incidence of lymph node metastasis [M(P25,P75)= 1.0(0,3.5)](p=0.04).These patients' 5-year OS rate and 5-year DFS rate after surgery were 84.4% and 77.1%,respectively.Univariate analysis showed that lymph node metastasis,clinical stage,joint ER/PR receptor status and endocrine therapy are the factors affecting the patients' 5-year OS.Lymph node metastasis,clinical stage and length of delay are the factors affecting the patients' 5-year DFS.Lymph node metastasis and ER status are the independent prognostic factors affecting the patients' 5-year OS while lymph node metastasis is the independent prognostic factor affecting the patients' 5-year DFS.In part two,the integrated results suggest the following: For the FAS-1377G/A polymorphism,we only found significant associations for allele G versus allele A(OR=1.100,95%CI=1.004-1.206,P=0.040).After stratification by ethnicity,a significant association was observed only for the AA+GA versus GG genotype in East Asian populations(OR=1.177,95% CI=1.010–1.371,P=0.037).The association was not found in West Asian populations.For the FAS-670A/G polymorphism,noassociation with cancer risk was found in any comparison model.Sensitivity analysis suggests that the meta-analysis results obtained after excluding any single study were similar to the original ones,suggesting that the meta-analysis results were not significantly affected by any single study.Conclusions1.The development of more appropriate preventive measures and treatment strategies according to the clinical epidemiological characteristics of female breast cancer patients aged ?35 years could improve their clinical outcomes.The results of this paper will lay the foundation for future researches on young breast cancer patients.2.These results indicated that FAS-1377G/A polymorphism may contribute to the increased breast cancer susceptibility and could be a promising target for cancer risk prediction. |
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