| Objective: Breast cancer is a common malignant tumour in women. The morbidity of female breast cancer is the highest among female tumour in developed countries. The morbidity of breast cancer in our country continues to rise in recent years and the morbidity in some big cities have reached the level of developed countries. The patients are younger in China and the treatment time has often been delayed. As a result, there are a considerable number of patients who are in the advanced stage of malignant tumour. Young women under the age of 40 are more inclined to a high degree of malignancy compared with patients over 40. More and more evidence indicated that patients under 40 years old have unique biological behaviour which played an important role in the process and development of the disease. Those caused the young breast cancer more likely to relapse, metastasis and death. The prognosis was poor as well. Therefore, we can estimate that breast cancer in young women may differ from other kinds of breast cancer in terms of clinical development process and molecular biological background. Due to the poor prognosis of young women breast cancer, the psychological state, work and lives may most probably be effected. These patients are in their prime time. Their disease must have great impact on the society and our nation as a whole. In recent years, the research on the diagnosis and treatment of breast cancer in young women has attracted increasing attention. Large sample studies abroad found that, compared with the older patients, the biological behaviour in young cancer patients are more invasive(including the ER negative, HER-2 over expression, histological grade and III stage, vascular invasion, P53 gene mutation or over expression, Ki-67 index increased, the proportion of S phase cells increased etc.), thus leading to their poor prognosis. Therefore we re-checked and followed cases from 2001 to 2010 in Hebei Breast Disease Diagnosis and Treatment Centre of young women with breast cancer and those who have accepted surgical treatment. In this way, we understand the pathological characteristics and later we carry out our prognosis analysis aiming at providing certain theoretical basis to the future young female breast cancer patients for individualised treatment and prognosis.Methods: We selected 1150 cases in Hebei Breast Disease Diagnosis and Treatment Centre from January 2001 to December 2010. The patients were all young women under 40, They had been diagnosed with primary breast cancer and accepted surgery. The age of onset was 18 to 40, average age 35.58, median age 37.We calculated the patients’ survival time from the time of diagnosis. The deadline we set was December 2014. The follow-up time ranged from 48 months to 168 months. We analysed the tumour size, surgical approach, lymph node metastasis, histological type, pathological stage, hormone receptor status, HER-2 expression and other indicators. Then we summarised the clinical and pathological of young women patients with breast cancer. The follow-up 485 cases adopted DFS and OS as an evaluation index and the above clinical parameters were analysed by single cox element. For the important cases, we used multiple cox element to make analysis. Finally, the independent influential factor causing poor prognosis in young women breast cancer would be obvious.Results:1 The number of young women with breast cancer showed an increasing trend in terms of morbidity. Most patients had a bigger than 2cm tumour when they went for a treatment. The surgery was mostly traditional modified radical mastectomy. The breast-conserving rate — 6.5% was relatively low. Invasive ductal carcinoma was 55.7% which is dominate in pathological type. Lymph node metastasis rate was 43.4% which is relatively high. The PTNM was late. ER, PR positive rate were low while HER-2 positive rate was high. The pathological features indicated that breast cancer in young women is more invasive. The lymphatic metastasis is earlier and the malignant level is higher. The prognosis is also poor.2 Obtained by Cox univariate analysis: The tumour size, lymph node metastasis, pathologic stage, histological type were statistically significant(P<0.05) for DFS; The lymph node metastasis, pathologic stage, histological type were statistically significant for OS(P<0.05). Obtained by Cox multivariate analysis: The lymph node metastasis, pathologic stage, histological type were statistically significant(P<0.05) for DFS; The lymph node metastasis, pathologic stage, histological type were statistically significant(P<0.05) for OS.Conclusions:1 Young women with breast cancer always in advanced stage when they go for treatments and they often have large solid tumour. There is more lymph node metastasis and their pathological features in invasive ductal carcinoma. The ER positive rate is low and the prognosis is poor.2 Lymph node metastasis, ER, histological type are the three independent influential factors affecting DFS and OS in young women breast cancer. |
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