J Cancer 2019; 10(14):3124-3132. doi:10.7150/jca.30432

Research Paper

Young-onset breast cancer: a poor prognosis only exists in low-risk patients

Jianfei Fu1*, Lunpo Wu2,3*, Tiantian Xu4, Dan Li5,6, Mingliang Ying7, Mengjie Jiang8, Ting Jiang9, Wei Fu10, Fan Wang11, Jinlin Du12✉

1. Department of Medical Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China.
2. Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
3. Institute of Gastroenterology, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
4. Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou 310029, Zhejiang Province, China.
5. Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
6. Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China.
7. Department of Radiology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
8. Department of Radiation Oncology. The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang Province, China.
9. Department of Nuclear Medicine, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China.
10. Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
11. Department of Oncology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China.
12. Department of Colorectal Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China.
* Jianfei Fu and Lunpo Wu are co-first authors; they have contributed equally to the work.

Abstract

The number of reported young breast cancer cases has increased dramatically recently. The impact of age on the outcomes of breast cancers remains controversial. Our study aimed to explore the factors that can stratify the impact of young age on the prognosis of early breast cancer patients. In total, 244,324 patients with early breast cancer in the Surveillance, Epidemiology, and End Results database were identified from 1990 to 2007. Survival curves were generated using the Kaplan-Meier method. The 5- and 10-year cancer-specific survival (CSS) rates were calculated using the Life-Table method. Multivariable analyses were used to identify prognosti c variables (without age) to construct the nomograms. The risk score developed from the nomogram was used to classify the cohort into three subgroups (low-, medium- and high-risk subgroup). Approximately 8.89% of women were diagnosed with breast cancer at a young age (≤ 40 years). Clinical nomogram had the potential ability to predict CSS accurately with a well C-index (0.785). Subgroup analysis indicated that the risk score as the sole factor can stratify the impact of young age on the prognosis of early breast cancer patients. Young breast cancer patients had a worse prognosis in the low-risk (HR=0.61; 95% CI: 0.57-0.65; P<0.001) or medium-risk subgroup (HR=0.89; 95% CI: 0.85-0.93; P<0.01) than in the high-risk subgroup (P=0.431). In conclusion, the worse prognosis of young women only appeared in the low- and medium-risk subgroups rather than in the high-risk subgroup. The risk score yielded from the nomogram model can assist clinical decision making for young breast cancer patients.

Keywords: Breast cancer, Survival, Age, Nomogram model, Risk score

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How to cite this article:
Fu J, Wu L, Xu T, Li D, Ying M, Jiang M, Jiang T, Fu W, Wang F, Du J. Young-onset breast cancer: a poor prognosis only exists in low-risk patients. J Cancer 2019; 10(14):3124-3132. doi:10.7150/jca.30432. Available from http://www.jcancer.org/v10p3124.htm