The Prognostic Impact of Age at Diagnosis Upon Breast Cancer of Different Immunohistochemical Subtypes: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Analysis

Abstract

Background and Objectives: The influence of age at diagnosis of breast cancer upon the prognosis of patients with different immunohistochemical (IHC)-defined subtypes is still incompletely defined. Our study aimed at examining the association of age at diagnosis and risk of breast cancer-specific mortality (BCSM). Methods: 172,179 eligible breast cancer patients were obtained for our study cohort using the Surveillance, Epidemiology, and End Results database from 2010 to 2015. Patients were classified into four IHC-defined subtypes according to their ER, PgR, and HER2 status. Kaplan-Meier plots were used to describe BCSM among patients in different age groups. A Cox proportional hazards model was used for multivariate analysis. A multivariable fractional polynomial model within the Cox proportional hazards model was used to evaluate the relationship between age at diagnosis and the risk of BCSM. Results: For the whole cohort, the median follow-up time was 43 months. Patients younger than 40 years and those older than 79 years presented with the worst BCSM (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.03-1.23, and HR 3.52, 95% CI 3.23-3.83, respectively, p < 0.01, with age 40-49 years as the reference). The log hazard ratios of hormone receptor (HoR)(+)/HER2(-) patients formed a quadratic relationship between age at diagnosis and BCSM, but not in the other three subtypes of breast cancer. In the HoR(+)/HER2(-) subtype, patients younger than 40 years had worse BCSM than those aged at 40-49 years (HR 1.26, 95% CI 1.10-1.45, and p < 0.01). Conclusions: Women diagnosed with HoR(+)/HER2(-) breast cancer younger than 40 years or older than 79 years of age suffer higher rates of cancer-specific mortality. Young age at diagnosis may be particularly prognostic in HoR(+)/HER2(-) breast cancer.

Breast-Conserving Therapy Has Better Prognosis for Tumors in the Central and Nipple Portion of Breast Cancer Compared with Mastectomy: A SEER Data-Based Study

“…Additionally, some early-stage patients still have worse survival in clinical studies (2,3). A series of studies revealed that age, primary tumor size, tumor location, positive axillary lymph nodes, histological grade, molecular subtype, and BRCA mutation were closely correlated with the prognosis of breast cancer (4)(5)(6)(7)(8)(9)(10).…”

Prognosis of triple-negative breast cancer associated with pregnancy: A propensity score-matched analysis from the French CALG (Cancer Associé à la Grossesse) network

“…The median age at diagnosis in our population of women with TN-PABC was 33.8 years (IQR 30.0e37.0) which was significantly lower than that of patients with TN-non-PABC (35.7 years; IQR 32.0e39.0). Previous studies have underlined that breast cancer diagnosed at a young age is correlated with lower survival rates and higher recurrence rates when compared with older patients [34,58,59]. Indeed, Liedtke et al found a significant correlation between age at diagnosis and overall survival, disease-free survival and distant disease-free survival in five age cohorts ( 30, 31e40, 41e50, 51e60 and >60 years) including 1732 patients with primary TNBC [58].…”

“…The median age at diagnosis in our population of women with TN-PABC was 33.8 years (IQR 30.0–37.0) which was significantly lower than that of patients with TN-non-PABC (35.7 years; IQR 32.0–39.0). Previous studies have underlined that breast cancer diagnosed at a young age is correlated with lower survival rates and higher recurrence rates when compared with older patients [ 34 , 58 , 59 ]. Indeed, Liedtke et al.…”

A new look at old problems: Ovarian function suppression in the real world

“…2,3 Recent well-controlled analyses have shown that the independent prognostic effect of young age is breast cancer subtype-specific and most evident in luminal-type breast cancers. [3][4][5] Luminal breast cancers express hormone receptors and thus are particularly susceptible to endocrine manipulations: adjuvant endocrine therapy or the chemo-endocrine effect of chemotherapy in premenopausal women. Although the prognostic value of chemotherapy-induced amenorrhea was acknowledged for many years, the role of ovarian ablation as a part of modern endocrine therapy for early breast cancers developing in premenopausal women has been long debated.…”

“…Despite demonstrated improvements for women of all ages, young women (40 years old or younger at diagnosis) appear to remain at increased risk for breast cancer mortality in comparison with older women 2,3 . Recent well‐controlled analyses have shown that the independent prognostic effect of young age is breast cancer subtype–specific and most evident in luminal‐type breast cancers 3‐5 …”