Objective: To examine the difference of long-term recurrence rate and survivals between the young patients and the old patients undergoing breast conserving therapy (BCT). Methods: Women with primary invasive breast cancer receiving BCT between December 1999 and December 2014 were selected retrospectively from the database of Breast Cancer Center, Peking University Cancer Hospital & Institute. The median age of all patients was 47 years (range: 21 to 91 years). The cases were categorized according to age at diagnosis into two subgroups: the ≤40 years group and the>40 years group. A total of 2 778 patients were included: 677 patients in the ≤40 years group and 2 101 patients in the >40 years group. Clinicopathological characteristics between two groups were compared. The recurrence rate and survival were calculated using the Kaplan-Meier method. The differences of outcomes were compared in different aged groups using the Log-rank test. Factors affecting local recurrence, distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) were assessed by multivariable Cox proportional hazard models. Results: Proportions of T1 (301/677 vs. 1 160/2 101, χ²=37.660, P<0.01), involved lymph node (314/677 vs. 713/2 101, χ²=34.966, P<0.01) hormone receptor-negative (490/677 vs. 1 581/2 101, χ²=6.981, P=0.030) and neoadjuvant chemotherapy (413/677 vs. 1 010/2 101, χ²=34.272,P<0.01)in the ≤40 years group were higher than that in the>40 years group. Median follow-up duration was 102 months. No significant difference in 10-year local recurrence was found between the two groups (2.5% vs. 1.6%, P=0.147). Ten-year DDFS rate in the ≤40 years group and in the>40 years group was 90.6% and 95.3%, respectively (P<0.01). Ten-year DFS rate in the ≤40 years group and in the>40 years group was 86.5% and 91.1%, respectively (P=0.001). Ten-year BCSS rate in the ≤40 years group and in the >40 years group was 91.0% and 93.7%, respectively (P=0.105). Age was not the prognosis factor of local recurrence. Lymph node status (positive vs. negative: HR=2.73, 95%CI: 1.94 to 3.84, P<0.01), age (≤40 years vs.>40 years: HR=1.73, 95%CI: 1.24 to 2.42, P=0.001) and T stage (>2 cm vs. ≤2 cm: HR=1.61, 95%CI: 1.14 to 2.28, P=0.001) were the prognosis factors of DDFS, and also for DFS. Hormone receptor status (positive vs. negative: HR=0.54, 95%CI: 0.39 to 0.74, P<0.01), lymph node status (positive vs. negative: HR=2.94, 95%CI: 2.12 to 4.07, P<0.01) and T stage (>2 cm vs. ≤2 cm: HR=1.45, 95%CI: 1.05 to 2.01, P=0.025) were the prognosis factors of BCSS. Conclusions: The risk of local recurrence was similar between ≤40 years patient and >40 years patients receiving breast conserving therapy. Worse survivals in the ≤40 years group were found comparing to those in the >40 years group.
目的： 探讨年龄对乳腺癌患者保留乳房治疗后长期复发及生存结局的影响。 方法： 从北京大学肿瘤医院乳腺癌预防治疗中心数据库中回顾性收集1999年12月至2014年12月2 778例原发性乳腺癌保留乳房治疗病例的资料，中位年龄47岁（范围：21~91岁）。根据发病年龄将患者分为≤40岁组（677例）与>40岁组（2 101例），比较两组患者的临床特征。采用Kaplan-Meier法绘制生存曲线，并用Log-rank法比较两组局部复发率、无远处转移动生存（DDFS）、无病生存（DFS）及乳腺癌特异性生存（BCSS），采用Cox比例风险模型分析复发及生存的预后因素。 结果： ≤40岁组和>40岁组的激素受体阳性比例（490/677比1 581/2 101，χ²=6.981，P=0.030）、腋窝淋巴结阳性比例（314/677比713/2 101，χ²=34.966，P<0.01）、T1期比例（301/677比1 160/2 101，χ²=37.660，P<0.01）、接受新辅助化疗比例（413/677比1 010/2 101，χ²=34.272，P<0.01）的差异均有统计学意义。中位随访102个月。≤40岁组和>40岁组10年局部复发率差异无统计学意义（2.5%比1.6%，P=0.147）。≤40岁组和>40岁组10年DDFS率分别为90.6%和95.3%（P<0.01），10年DFS率分别为86.5%和91.1%（P=0.001），10年BCSS率分别为91.0%和93.7%（P=0.105）。年龄不是局部复发的独立预后因素（P>0.05）；淋巴结状态（阳性比阴性，HR=2.73，95%CI：1.94~3.84，P<0.01）、年龄（≤40岁比>40岁，HR=1.73，95%CI：1.24~2.42，P=0.001）、肿瘤最大径（>2 cm比≤2 cm，HR=1.61，95%CI：1.14~2.28，P=0.001）是DDFS和DFS的独立预后因素；激素受体状态（阳性比阴性，HR=0.54，95%CI：0.39~0.74，P<0.01）、淋巴结状态（阳性比阴性，HR=2.94，95%CI：2.12~4.07，P<0.01）、肿瘤最大径（>2 cm比≤2 cm，HR=1.45，95%CI：1.05~2.01，P=0.025）是BCSS的独立预后因素。 结论： ≤40岁与>40岁乳腺癌患者保留乳房治疗后局部复发风险相似，前者长期生存劣于后者。.