Bl. Fowble et al., THE INFLUENCE OF YOUNG AGE ON OUTCOME IN EARLY-STAGE BREAST-CANCER, International journal of radiation oncology, biology, physics, 30(1), 1994, pp. 23-33
Citations number
45
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To assess the impact of young age on outcome in women with ea
rly stage breast cancer undergoing conservative surgery and radiation.
Methods and Materials: Between 1981 and 1991, 980 patients with Stage
I and II breast cancer underwent excisional biopsy, axillary dissecti
on, and radiation. The median follow-up was 4.6 years, with a range of
I month to 11 years. The patients were divided into three groups, bas
ed on age at the time of diagnosis: (a) age less than or equal to 35 y
ears-64 patients, (b) age 36-50 years-363 patients, and (c) age greate
r than or equal to 50 years-553 patients. The comparability of the gro
ups was assessed in terms of clinical factors (tumor size and race), h
istopathologic factors (histologic subtype, final resection margin, es
trogen and progesterone receptor status, pathologic nodal status), and
treatment related factors (reexcision, median total dose to the prima
ry, region(s) treated with radiation, and the use of adjuvant systemic
chemotherapy and/or tamoxifen). Outcome was evaluated for overall, re
lapse-free, and cause-specific survival and patterns of first failure
(breast, regional nodes, and distant metastasis). Results: There were
no significant differences among the three groups in terms of race, cl
inical tumor size, pathology of the primary tumor, pathologic nodal st
atus, final margin of resection, progesterone receptor status, median
total dose to the primary tumor, or the regions treated. However, youn
ger women were significantly more likely to have estrogen receptor neg
ative tumors, undergo reexcision, and receive adjuvant systemic chemot
herapy without tamoxifen. Younger women were found to have a statistic
ally significantly decreased 8-year actuarial relapse-free survival (5
3% vs. 67% vs. 74%, p = 0.009), cause-specific survival (73% vs. 84% v
s. 90%, p = 0.02), freedom from distant metastasis (76% vs. 75% vs. 83
%, p = 0.02), and a significantly increased risk of breast recurrence
(24% vs. 14% vs. 12%, p = 0.001), and regional node recurrence (7% vs.
1% vs. 1%, p = 0.0002). The patients were further divided on the basi
s of their pathologic nodal status. There were no statistically signif
icant differences among the three age groups for axillary node-positiv
e patients for overall survival (75% vs. 80% vs. 74%), relapse-free su
rvival (73% vs. 73% vs. 62%), cause-specific survival (76% vs. 85% vs.
80%), and freedom from distant metastasis (75% vs. 75% vs. 72%), or b
reast recurrence (0% vs. 9% vs. 6%). The findings were identical when
the analysis was restricted to node-positive patients who received che
motherapy. However, for axillary node-negative women, young age was as
sociated with a statistically significant decreased overall survival(7
1% vs. 83% vs. 92%), relapse-free survival (51% vs. 65% vs. 76%), caus
e-specific survival(71% vs. 86% vs. 93%), freedom from distant metasta
sis (77% vs. 76% vs. 88%), and a statistically significant increased r
isk of breast recurrence (40% vs. 16% vs.13%), and regional node recur
rence (3% vs. 1% vs. 0%). The risk of a breast recurrence in axillary
node-negative young women was decreased by the addition of adjuvant sy
stemic chemotherapy but not by the use of reexcision. Conclusions: The
present analysis demonstrates that young women with early stage breas
t cancer do significantly worse when compared to older women in terms
of relapse-free survival, cause-specific survival, distant metastasis
and breast and regional node recurrence. However, the adverse effect o
f young age on outcome appears to be limited to the node-negative pati
ents. These findings suggest that node-negative early stage breast can
cer in young women is a more aggressive disease, with an increased ris
k for all patterns of failure and a decreased survival.