This article is more than 5 years old. Information may no longer be current.
Age at diagnosis predicts survival in breast cancer subtype
Click Here to Manage Email Alerts
Women diagnosed with luminal A breast cancer when aged 40 years or younger had significantly worse 5-year EFS outcomes than those diagnosed when aged 41 to 60 years, according to a retrospective institutional cohort study published in Breast Cancer Research & Treatment.
“It’s generally accepted that young patients typically have a more aggressive disease, and therefore do more poorly,” Christopher Umbricht, MD, PhD, associate professor of oncology at the Kimmel Cancer Center at Johns Hopkins Hospital, said in an interview with HemOnc Today. “It’s also fairly accepted that the luminal A breast cancer type is usually the least aggressive. It’s more easily treatable — you can often avoid chemotherapy altogether, and patients often have a much more indolent course than other breast cancer subtypes.”
Although previous studies have reported that age has an impact on breast cancer survival, data are lacking on how age impacts outcomes according to molecular subtype.
The analysis included 3,524 women who underwent mastectomy or lumpectomy at The Johns Hopkins Hospital for a first invasive breast cancer between 2000 and 2016.
Researchers classified patients by molecular subtype — including luminal A (54%), luminal B-HER2 negative (13%), luminal B-HER2 positive (12%), HER2 overexpressed (6%) and triple negative (16%) — and age (40 years and younger, n = 395; 41-60 years, n = 1,838; 60 years and older, n = 1,291).
Median follow-up was 85.1 months (range, 1-191.7).
In an age-stratified analysis, only patients with luminal A breast cancer had significantly different 5-year DFS and distant metastasis-free survival. Patients aged 40 years or younger showed significantly worse 5-year DFS (HR = 2.69; 95% CI, 1.72-4.23) and distant metastasis-free survival (HR = 2.95; 95% CI, 1.78-4.9) compared with patients aged 41 to 60 years.
Researchers also observed worse outcomes among patients with luminal A disease aged older than 60 years in terms of DFS (HR = 1.82; 95% CI, 1.34-2.47) and distant metastasis-free survival (HR = 1.9; 95% CI, 1.33-2.7).
The analysis did not reveal significant associations between age at diagnosis and DFS or distant metastasis-free survival in the luminal B-HER2 negative, luminal B-HER2 positive, HER2 overexpressed, or triple-negative subtypes.
Age appeared to be a stronger predictor of outcome than tumor grade or proliferative index
among patients with luminal A breast cancer, but not in other subtypes.
Additionally, the researchers identified differentially expressed genes between age groups among breast cancer subtypes in The Cancer Genome Atlas. They conducted a weighted gene co-expression network analysis to identify key driver genes within the differentially expressed genes.
Researchers identified 374 differentially expressed genes in the luminal A breast cancer subgroup that were augmented in seven pathways and two modules of co-expressed genes. However, researchers observed no difference in expression of these genes based on age.
“I think the message here is basically to beware,” Umbricht told HemOnc Today. “Don’t be fooled because the patient has a luminal A subtype, which is felt to be less aggressive. If you have a young patient, these patients may do more poorly than you’d expect.” – by Jennifer Byrne
For more information:
Christopher B. Umbricht , MD, PhD, can be reached at cumbrich@jhmi.edu.
Disclosures : The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts