Age of 40 Years or Younger Is an Independent Risk Factor for Locoregional Failure in Early Breast Cancer: A Single-Institutional Analysis in Saudi Arabia
Background. This study was undertaken to evaluate the impact of prognostic factors on the locoregional failure-free survival of early breast cancer patients. Methods. In this single-institutional study, 213 breast cancer patients were retrospectively analysed. Fifty-five of 213 patients were ≤40 years of age at diagnosis. The impact of patient- or treatment-related factors on the locoregional failure-free survival was assessed using the Kaplan-Meier method. The simultaneous impact of factors on the locoregional failure-free survival was assessed using the Cox proportional hazards regression analysis. Results. The median follow-up time of the censored patients was 22 months (mean 28 months, range 3–92 months). On univariate analysis, statistically significant factors for the locoregional failure-free survival were the age (≤40 versus >40 years), T stage (Tis, T0–2 versus T3-4), molecular tumor type (luminal A versus luminal B, Her2neu overexpression, or triple negative), and lymphovascular status (LV0 versus LV1). On multivariate analysis, age and T stage remained statistically significant. Conclusions. Being 40 years or younger has a statistically significant independent adverse impact on the locoregional failure-free survival of patients with early breast cancer. 1. Background Approximately 3.7%–7.5% of the total number of breast cancer patients diagnosed each year in the US [1, 2] and Western Europe [3–5] are younger than 40 years. In Saudi Arabia, the proportion of breast cancer patients ≤40 years at diagnosis is dramatically larger with 25.1% [6]. Multiple retrospective series and subset analyses of larger randomized trials have shown that young patients with breast cancer have a poorer prognosis [7–16] compared to older age at diagnosis. Breast cancer patients ≤40 years tend to have more triple-negative and fewer luminal A and B breast cancers [17–19], tumors of higher grade, more extensive intraductal component, more lymphovascular invasion, more likely estrogen receptor- (ER-) negative tumors [20–23], and more often BRCA-1 or -2 germline mutations [13, 24–27]. Although young women do appear to have tumors with more aggressive biological characteristics, younger age has been shown in several studies to be an independent predictor of adverse outcome [18, 20, 22, 28–31]. Several current consensus guidelines have included age ≤35 years as an absolute indication for adjuvant systemic chemotherapy irrespective of other tumor characteristics [32–35]. More research is needed to optimize the treatment for this patient group [14, 36, 37]. Detailed data
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