| Objective:Premenopausal breast cancer and postmenopausal breast cancer are two different types of breast cancer with different causes,prognosis and influencing factors.Therefore,this study aims to explore the differences between premenopausal and postmenopausal breast cancer patients in terms of epidemiological characteristics,clinicopathological characteristics,treatment modalities and prognostic factors,in order to better guide the treatment work.Methods:A retrospective study was conducted on the clinicopathological data and follow-up information collected from 600 women with breast cancer premenopausal and postmenopausal breast cancer patients who were admitted to the First Affiliated Hospital of Kunming Medical University on Januaryl,2012and December 31,2019.Chi square test was used to compare the differences between the two groups in epidemiology,clinicopathological characteristics and treatment methods,as well as the relationship between different BMI groups and clinicopathological characteristics of premenopausal and postmenopausal breast cancer,Cox regression model was used to analyze the relationship between clinicopathological features and prognosis.Log rank test and Kaplan Meier were used to draw survival curve.Results:A total of 600 patients were enrolled on December 31,2019,with an average age of 49.9 years,including 331 premenopausal breast cancer patients and 269 postmenopausal breast cancer patients.The median follow-up time was 52 months and 41 months,and the mean age was 42.0 years and 59.6 years,respectively.1.Comparison of clinicopathological features:ER positive expression in postmenopausal group was higher than that in premenopausal group(64.7%vs 51.1%,p=0.001);lymph node metastasis rate in premenopausal group was higher than that in postmenopausal group(51.6%vs 46.8%,p=0.014),and distant metastasis rate in postmenopausal group was higher than that in premenopausal group(3.3%vs 0.9%,p=0.034).There was no significant difference between the two groups in tumor size,stage,histological grade,PR expression,Her-2 expression status,Ki-67 percentage and molecular subtype.2.Treatment:compared with postmenopausal group,patients in premenopausal group were more likely to receive breast conserving therapy(15.4%vs 9.7%)and breast reconstruction(10.6%vs 0.7%)(p<0.001).3.The results of univariate analysis of premenopausal breast cancer patients showed:①The larger the tumor,the worse the prognosis of patients.The death risk of T4 patients is 11.934 times that of T1 patients.②The death risk of N3 patients is 7.78 times that of NO patients,and the death risk of N2 patients is 4.659 times that of NO patients.③The death risk of M1 patients is 17.641 times that of M0 patients.④The death risk of stage Ⅳ patients is 23.323 times that of stage I patients.⑤The negative expression of ER and PR is a poor prognostic factor for patients.The risk of death in ER and PR negative patients is 3.143 times and 3.677 times that of positive patients.⑥The death risk of triple-negative patients was 3.388 times that of Luminal breast cancer patients,and the prognosis was worse than that of Luminal breast cancer,but the difference was not statistically significant(P=0.060).⑦The prognosis of patients undergoing neoadjuvant therapy is worse than that of patients who do not need or have not undergone neoadjuvant therapy.The risk of death for patients undergoing neoadjuvant therapy is 3.099 times that of patients who have not undergone neoadjuvant therapy.And age group,ethnicity,history of pregnancy,history of miscarriage,history of breastfeeding,family history of tumor,BMI,histological grade,Her-2 expression status,Ki 67 percentage,surgical method,whether to use adjuvant chemotherapy,whether to use targeted therapy,there was no statistically significant difference in the prognosis of premenopausal breast cancer patients with or without adjuvant endocrine therapy,radiotherapy or not.The results of univariate analysis of postmenopausal breast cancer patients showed:①The larger the tumor,the worse the prognosis of patients.The death risks of T4 and T3 patients are 18.105 times and 8.356 times that of T1 patients,respectively.②The death risk of N3 patients is 9.47 times that of NO patients.③The death risk of M1 patients is 8.571 times that of M0 patients.④The later the stage,the worse the prognosis,and the risk of death is 12.881 times and 4.149 times that of stage Ⅰ patients.⑤The negative expression of ER and PR is a poor prognostic factor for patients.The risk of death in ER and PR negative patients is 2.502 times and 4.458 times that of positive patients.⑥The prognosis of HER-2 positive patients was worse than that of HER-2 negative patients.The risk of death of HER-2 positive patients was 3.099 times higher than that of HER-2 negative patients.⑦The prognosis of Her-2 positive patients is worse than that of Luminal type patients.The death risk of Her-2 positive breast cancer patients is 3.748 times that of Luminal type patients.⑧The prognosis of patients undergoing endocrine therapy is better than that of patients without or without endocrine therapy.⑨The prognosis of patients undergoing neoadjuvant therapy is significantly worse than that of patients who do not need or receive neoadjuvant therapy.And ethnicity,history of pregnancy,history of miscarriage,history of breastfeeding,family history of tumor,BMI,histological grade,Ki 67 percentage,surgical method,whether to use adjuvant chemotherapy,whether to use targeted therapy,whether to use radiotherapy,and postmenopausal breast cancer patients the difference in prognosis was not statistically significant.4.Multivariate analysis of premenopausal breast cancer patients showed that tumor size and number of lymph node metastasis were prognostic factors of OS5.The relationship between BMI and clinicopathological features of postmenopausal breast cancer.The results showed that the frequency of histological grade(grade Ⅱ andⅢ)in overweight and obesity group(≥25kg/m2)was higher than that in normal weight group(P=0.042).BMI was a prognostic factor of OS in postmenopausal breast cancer.6.The proportion of Han patients in premenopausal group was lower than that in postmenopausal group(87.3%vs 93.3%,p=0.015).The number of pregnancies in premenopausal group was more than that in postmenopausal group(6.3%vs 1.5%,p=0.003)Conclusions:1.The ER positive rate of postmenopausal breast cancer is high,and endocrine therapy is feasible.The rate of lymph node metastasis in premenopausal group was higher than that in postmenopausal group,while the rate of distant metastasis in postmenopausal group was higher.2.Compared with the postmenopausal group,the premenopausal group is more likely to receive breast conserving therapy and breast reconstruction.3.Tumor size,number of lymph node metastasis,distant metastasis,staging,ER expression,PR expression,molecular typing,neoadjuvant therapy(PCR and non-PCR)were the single factor prognostic factors of premenopausal and postmenopausal breast cancer.In addition,Her-2 expression and endocrine therapy were the single factor prognostic factors of postmenopausal breast cancer.4.The independent influencing factors of OS in premenopausal breast cancer patients were tumor size and number of lymph node metastasis.5.Postmenopausal breast cancer patients with BMI≥25Kg/m2 have higher histological grades.BMI is an independent prognostic factor of OS in postmenopausal breast cancer patients.Due to the small sample size included in this study,larger data support is needed.In view of the above results,clinicians may consider adopting different clinico-pathological parameters as reference factors for diagnosis and treatment of pre-and postmenopausal breast cancer,so as to provide patients with a more accurate and individualized diagnosis and treatment model. |
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