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目的 :探讨原发性乳腺癌确诊时年轻是否为不良预后因素 ,以及病期和治疗如何影响年龄与预后关系。设计 :乳腺癌患者的详细情况包括肿瘤特征、治疗方案和生存的回顾性队列研究。地点 :丹麦。对象 :10 35 6例原发性乳腺癌患者 ,确诊时年龄小于 5 0岁。主要结果判定 :对已知预后因素和预期死亡率调整后 ,根据确诊时年龄 ,测定确诊后头 10年内相对死亡危险。结果 :总体上讲 ,未接受辅助治疗的低危年轻患者死亡风险明显增加 ;随着确诊时年龄降低 ,风险亦增加。调整后相对风险 :45～ 49岁 (作为参照 ) :1;40～ 44岁 :1 12 (95 %可信区间为0 89～ 1 40 ) ;35～ 39岁 :1 40 (1 10～ 1 78) ;<35岁 :2 18(1 6 4～ 2 89)。然而 ,接受辅助细胞毒治疗的患者没有看到类似倾向。在淋巴结阴性并按肿瘤大小分组的患者中 ,与接受辅助治疗者相比 ,未接受辅助治疗的年轻患者风险增加。结论 :年轻对预后的不良作用几乎仅见于未接受辅助细胞毒治疗的年轻低危患者。结果表明 ,年轻乳腺癌患者 ,单纯就年龄而言 ,应视为高危患者并接受辅助细胞毒的药物治疗
Objectives: To investigate whether young adults are a poor prognostic factor in the diagnosis of primary breast cancer, and how the disease period and treatment affect the relationship between age and prognosis. Design: Details of breast cancer patients include a retrospective cohort study of tumor characteristics, treatment options, and survival. Location: Denmark. PARTICIPANTS: A total of 10 356 primary breast cancer patients were diagnosed at age less than 50 years old. Main Outcome Determination: After adjustment for known prognostic factors and expected mortality, the relative risk of death within the first 10 years of diagnosis was determined based on the age at diagnosis. Results: Overall, the risk of death was significantly higher in low-risk young patients who did not receive adjuvant therapy, and the risk increased with age at the time of diagnosis. Adjusted relative risk: 45 to 49 years old (as a reference): 1; 40 to 44 years old: 1 12 (95% confidence interval 0 89 to 1 40); 35 to 39 years old: 1 40 (1 10 to 1 78) ); <35 years old: 2 18 (1 6 4 to 2 89). However, patients who received adjuvant cytotoxic therapy did not see similar trends. Among patients with negative lymph node and grouped by tumor size, young patients who did not receive adjuvant therapy had an increased risk compared with those who received adjuvant therapy. Conclusion: The adverse effects of youth on prognosis are almost exclusively seen in young low-risk patients who have not received adjuvant cytotoxic therapy. The results showed that young breast cancer patients, just in terms of age, should be regarded as high-risk patients and receive drug treatment for cytotoxicity