한빛사논문
- 조회364
Dong Seung Shin, MD1; Janghee Lee, MD2,3; Eunhye Kang, MD, PhD4,5; Dasom Noh, MS6; Jong-Ho Cheun, MD7; Jun-Hee Lee, MD, PhD8; Yeongyeong Son, BS6; Soong June Bae, MD9; Seok Won Kim, MD, PhD1; Jeong Eon Lee, MD, PhD1; Jonghan Yu, MD, PhD1; Byung-Joo Chae, MD, PhD1; Sunyoung Kwon, PhD6,10,11; Han-Byoel Lee, MD, PhD4,5,12; Sung Gwe Ahn, MD, PhD9,13; Jai Min Ryu, MD, PhD1
1Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, Republic of Korea
2Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University, Dongtan, Republic of Korea
3Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
4Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
5Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
6Department of Information Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Busan, Republic of Korea
7Department of Surgery, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Republic of Korea
8Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
9Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
10School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea
11Center for Artificial Intelligence Research, Pusan National University, Busan, Republic of Korea
12Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
13Institute for Breast Cancer Precision Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Corresponding Author: Jai Min Ryu, MD, PhD
Abstract
Importance Young patients with breast cancer with estrogen receptor (ER)–positive, ERBB2-negative tumors have a poor prognosis. Understanding factors influencing late recurrence is crucial for improving management and outcomes.
Objective To determine whether age is an independent factor associated with late distant recurrence (DR) in young patients with ER-positive, ERBB2-negative cancers without distant metastasis within 5 years from surgery.
Design, Setting, and Participants This multicenter retrospective cohort study analyzed clinical records of patients with breast cancer who underwent surgery from January 2000 to December 2011 with at least 5 years of follow-up. The study was conducted at Samsung Medical Center, Gangnam Severance Hospital, and Seoul National University Hospital, including patients aged 45 years or younger with ER-positive, ERBB2-negative tumors, no DR within 5 years after surgery, no neoadjuvant chemotherapy, and at least 2 years of endocrine therapy. The data analysis period was from January 4, 2023, to March 21, 2024.
Exposure Age, grouped as 21 to 35 years, 36 to 40 years, and 41 to 45 years.
Main Outcomes and Measures The primary outcome was the incidence of late DR at 5 to 10 years after surgery. Survival outcomes, including late distant metastasis–free survival (DMFS), were evaluated in different age groups.
Results Among 2772 patients included, 370 (13.3%) were aged 21 to 35 years, 885 (31.9%) were aged 36 to 40 years, and 1517 (54.7%) were aged 41 to 45 years. The median (range) follow-up was 10.8 (5.0-21.4) years. The youngest group had a poorer histologic grade (eg, histologic grade 3: 107 patients aged 21-35 years [28.9%]; 149 patients aged 36-40 years [16.8%]; 273 patients aged 41-45 years [18.0%]) and more frequent chemotherapy (307 patients aged 21-35 years [83.0%]; 697 patients aged 36-40 years [78.8%]; 1111 patients aged 41-45 years [73.2%]). The youngest patients had significantly worse rates of locoregional recurrence–free survival (patients aged 21-35 years, 90.1% [95% CI, 86.8%-93.3%]; patients aged 36-40 years, 94.6% [95% CI, 93.0%-96.2%]; patients aged 41-45 years, 97.7% [95% CI, 96.9%-98.5%]), disease-free survival (patients aged 21-35 years, 79.3% [95% CI, 75.0%-83.9%]; patients aged 36-40 years, 88.7% [95% CI, 86.5%-91.0%]; patients aged 41-45 years, 94.4% [95% CI, 93.2%-95.7%]), and late DMFS (patients aged 21-35 years, 89.3% [95% CI, 86.0%-92.9%]; patients aged 36-40 years: 94.2% [95% CI, 92.5%-95.9%]; patients aged 41-45 years: 97.2% [95% CI, 96.3%-98.1%]) but not overall survival (patients aged 21-35 years, 96.9% [95% CI, 95.0%-98.9%]; patients aged 36-40 years, 98.2% [95% CI, 97.2%-99.2%]; patients aged 41-45 years, 98.9% [95% CI, 98.3%-99.5%]). Multivariable analysis showed lower hazard for late DR in the older groups compared with the youngest group (age 36-40 years: hazard ratio, 0.53; 95% CI, 0.34-0.82; P = .001; age 41-45 years: hazard ratio, 0.30; 95% CI, 0.20-0.47; P < .001).
Conclusions and Relevance In this retrospective cohort study, age was an independent factor associated with late DR in young patients with ER-positive, ERBB2-negative breast cancer. Younger age was associated with worse locoregional recurrence–free survival, disease-free survival, and late DMFS, highlighting the importance of long-term monitoring and potential for personalized treatment approaches based on age, particularly for younger patients with ER-positive, ERBB2-negative breast cancer.
논문정보
- Research article
- 2024년 11월 (BRIC 등록일 2024-11-08)
- 국내 연구진
- 의약학 > 종양의학
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