Prognosis Of 162 Young Breast Cancer And Its Related Risk Factors

Objectives:A retrospective study of 162 cases of young breast cancer female patients admitted to the "First Affiliated Hospital of Kunming Medical University" for a total of 183 months from January 1,2003 to March 31,2018 by statistical methods.To analyze the molecular subtype of young breast cancer,and to analyze the factors that may affect the prognosis of young breast cancer such as age,region,surgery,tumor size,nodal status,distant metastasis status,Her-2 expression status,TNBC,menarche age,family history,pregnancy history,PABC.Methods:This study is a retrospective study.Inclusion criteria:female cases aged ≤3 5-years old and diagnosed with invasive breast cancer by pathological examination.Exclusion criteria:age>35-years old,male breast cancer,primary malignant tumor confirmed by pathological examination or other reliable imaging examination,DCIS,LCIS,breast sarcoma,breast malignant phyllodes tumor,simple nipple and areola eczema-like changes without any deep breast lesions(Paget disease),IBC,cases with incomplete clinical data,cases lost to follow-up,and cases that cannot be statistically analyzed.When there are disputes about the inclusion and exclusion of cases,the investigator will make a judgment after discussing with a third party who is unaware of the study.After the screening,follow-up will be conducted,and the follow-up time will expire on December 31,2019.The follow-up results are summarized to perform tumor TNM staging according to the 8th edition of AJCC,and the molecular subtype is based on the 2018.V1 version of the CSCO guidelines for the diagnosis and treatment of breast cancer.The starting point of observation of survival rate was the date when the patient was admitted to the hospital for the first diagnosis of breast cancer.The calculation method was the length of the interval from the starting point to the end of follow-up or the length from the starting point to the date of death of the patient.Statistical analysis was performed on the demographic characteristics of the included cases.Analyze the survival status of all included cases,and use Kaplan-Meier method to calculate the 1-year survival rate,3-year survival rate,5-year survival rate,and 10-year survival rate;Compare whether there are significant differences in molecular subtype between different age groups of young breast cancer(age≤25 and 25<age≤35).The Log-Rank method was used to analyze the correlation between age,geographical situation of Yunnan Province,surgery,tumor size,nodal status,distant metastasis status,Her-2 expression status,TNBC,menarche age,family history,pregnancy history,PABC and prognosis separately.COX proportional hazards regression model was used to analyze the relevant factors affecting the prognosis of young breast cancer.P<0.05 was considered statistically significant.The statistical analysis software is SPSS 23.0.Results:1.In this study,235 cases of young breast cancer were collected,73 cases were lost to follow-up(the rate of lost follow-up was 31.06%),and 162 cases were included.The median age of onset was 32,with the largest number of patients between 30 and 35,105 cases(64.81%),and the youngest patient was a 20-year-old female.The molecular subtype is at most Luminal B,53 cases(32.72%),followed by TNBC,44 cases(27.16%),Her-2 positive is not much different from TNBC,43 cases(26.54%),Luminal A was the least,22 cases(13.58%).When diagnosed for the first time,there were the most cases of stage Ⅱ,91 cases(56.17%),39 cases of stage Ⅰ(2 4.07%),21 cases of stage Ⅲ(12.96%),and 11 cases of stage Ⅳ(6.79%).6 cases of pregnancy associated breast cancer(PABC).In 11 cases,pregnancy occurred after diagnosis of breast cancer.75 cases(46.30%)were negative for ALN.The 1-,3-,5-,and 10-year overall survival rates were 97.53%,92.59%,90.74%,and 86.42%,respectively.The 5-year survival rate of young breast cancer cases diagnosed between 2003 and 2014 was 89.25%,and the 10-year survival rate of young breast cancer cases confirmed between 2003 and 2009 was 82.93%.2.There was no statistically significant difference in molecular subtype between patients ≤25 years old and 25<age≤35 years old,P=0.977.3.There were statistically significant differences between whether to undergo surgery,tumor size,nodal status,Her-2 expression status,family history,and prognosis of young breast cancer.The 5-year survival rate of patients treated with surgery was 92.62%,and the prognosis was significantly better than that of patients without surgery.Patients with different tumor sizes have significantly different prognosis.The smaller the tumor,the better the prognosis,when the tumor invades the skin and/or chest wall,the prognosis is the worst,with a 1-year survival rate of 66.67%and a 5-year survival rate of 50%.The median survival time when the tumor invaded the skin and/or chest wall was only 26 months.Patients with negative axillary lymph nodes have a better prognosis than those with positive.The prognosis of Her-2 negative patients is better than that of Her-2 positive patients.Patients without a family history had a better prognosis than patients with a family history,with a median OS of 37 months in patients with family history.There was no statistically significant difference in the prognosis of age,geographical conditions in Yunnan province,distant metastasis,TNBC,menarche age,pregnancy history,and pregnancy associated breast cancer(PABC).4.The results of COX proportional hazard regression model analysis showed whether surgery(P=0.019),tumor size(P=0.004),axillary lymph node status(P=0.028),distant metastasis status(P=0.020),Her-2 expression Status(P=0.038),family history(P=0.033),and pregnancy history(P=0.043)all had P values<0.05,and the differences were statistically significant.The risk of death for surgical patients was 0.216 times that of patients without surgery.The prognosis of tumors of different sizes is significantly different,and the prognosis of large tumors is worse.The regression coefficient of T3 tumor size is 2.664,and the death risk ratio is 14.358;The risk of death in patients with positive axillary lymph nodes is 3.233 times the risk of death in patients with negative axillary lymph nodes;the risk of death in patients without distant metastases is 0.053 times that in patients with distant metastases;The risk of death for Her-2 positive patients is 3.221 times that of non-Her-2 positive patients;The risk of death in patients with a family history was 4.151 times the risk of death in patients without a family history;the risk of death in patients with a history of pregnancy was 0.226 times that in patients without a history of pregnancy.The age at onset(P=0.433),whether it was triple negative breast cancer(P=0.384),menarche age(P=0.093),and pregnancy-associated breast cancer(P=0.668)all had a P value of>0.05,and there was no significant difference significance.5.In this study,11 patients had natural pregnancy after diagnosis of breast cancer,of which 6 were planned and 5 were unexpected pregnancy.The pregnancy rate is 6.79%.8 patients gave birth to healthy live births via cesarean section or cesarean section,of which 1 case was breastfed,3 cases were breastfed combined with milk powder,and 4 cases were fed with milk powder.1 case had an abortion,1 case was 28 weeks pregnant until the day of follow-up,and one case had fetal cardiac arrest in the first trimester(6 weeks).One patient had an unexpected pregnancy during the breast cancer treatment period.Then,the patient stopped breast cancer-related treatment on her own,and then gave birth to a healthy baby girl by cesarean section.Eventually,the patient died in the second month of lactation.Conclusions:1.Among the molecular subtypes in this study,Luminal B is the largest(32.72%),followed by triple negative breast cancer(27.16%)and Her-2 positive(26.54%),and Luminal A is the lowest(13.58%).There were no differences in molecular subtypes among different age subgroups(age≤25 and 25<age≤35).The age of onset is mostly over 30 years,the median age of onset is 32,and there are very few young breast cancers under 25.Stage Ⅱ is the most common stage when young breast cancer is diagnosed(56.17%),with a few advanced cases(6.79%).The 5-year survival rate was 90.74%,and the 10-year survival rate was 86.42%.2.The smaller the tumor,the better the prognosis,the worst prognosis is when the tumor invades the skin and/or chest wall.The prognosis of patients treated with surgery is better than that of patients without surgery.Patients with negative axillary lymph nodes have a better prognosis than patients with positive axillary lymph nodes.Patients without family history have a better prognosis than patients with family history.Non-Her-2 positive patients have a better prognosis than Her-2 positive patients.This study shows that patients with small tumors,suigical treatment,axillary lymph node negatives,no family history,and non-Her-2 positive patients have a better prognosis.3.Seven variables,including whether to undergo surgery,tumor size,axillary lymph node status,distant metastasis status,Her-2 positive,family history,and pregnancy history,are all risk factors that affect the prognosis of young breast cancer patients.Young patients with small tumors,surgical treatment,axillary lymph node negative,no distant metastasis,non-Her-2 positive,pregnancy history and no family history have a better prognosis.Young breast cancer patients with large tumors,no surgical treatment,axillary lymph node metastases,distant metastases,Her-2 positive,family history,and no pregnancy history have a poor prognosis.This study demonstrates that early detection,early diagnosis,and early treatment of breast cancer should be strengthened.Young breast cancers with large tumors,no surgical treatment,positive axillary lymph nodes,distant metastases,Her-2 positive,family history,and no pregnancy history should be treated relatively aggressively.4.To pay more attention to the fertility problems of young breast cancer patients.