Buket ALTUN ÖZDEMİR, Servet KOCAÖZ, Bülent ÇOMÇALI, Mustafa Ömer YAZICIOĞLU, Fırat CANLIKARAKAYA, Cengiz CEYLAN, Birol KORUKLUOĞLU

40 YAŞ ALTI VE 55 YAŞ ÜSTÜ MEME KANSERLİ KADINLARIN KLİNİKOPATOLOJİK VE RADYOLOJİK BULGULARININ SAĞ KALIM ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Amaç Meme kanserli kadınların tümörleri, yaşla birlikte gelişen hormonal değişikliklere bağlı olarak klinik ve biyolojik farklılıklar göstermektedir. Bu nedenle bu çalışmada meme kanserli hastaların <40 yaş ve ≥55 yaşlarının radyolojik ve klinikopatolojik özelliklerini karşılaştırdık. Gereç ve Yöntem 10 yıllık dönemde üç merkezde meme kanseri nedeniyle opere edilen 40 yaş altı 92 hasta ve 55 yaş ve üzeri 322 hasta olmak üzere toplam 759 hastanın dosyaları geriye dönük olarak incelendi ve Östrojen Reseptör (ER), Progesteron Reseptör (PR), İnsan Epidermal Büyüme Faktörü 2 (HER2) ,Lenfovaskuler İnvazyon ( LVI ) durumu, Aksiller Lenf Nodu Metastazı (ALNM) varlığı, multifokalite, Duktal Karsinoma İnsitu (DCIS) veya Lobuler Karsinoma İnsitu (LCIS) varlığı, tümör boyutu, tümör histopatolojik tipi, tümör derecesi ve skoru kaydedildi. Bulgular 40 yaşın altındaki hastalarda tümörün memenin üst-iç ve alt-iç kadranlarında daha az yerleştiği, multifokalitenin ise daha sık görüldüğü, büyük bir çoğunluğunun dens meme yapısına sahip olduğu, tümörün histolojik derecesinin yüksek olduğu, LVI ve LNM’nin daha sık görüldüğü, daha düşük ER reseptör pozitifliği ve daha yüksek Ki-67 proliferasyon indeksine sahip olduğu saptandı (sırasıyla p<0.001, p<0.001, p<0.001, p<0.001, p=0.021, p=0.039, p=0.001 ve p<0.001). 55 yaşının altındaki hastalarda tümörlerde multifokalitenin ve meme dokusunun yoğunluğunun daha az olduğu görüldü (sırasıyla p=0.002, p<0.001). 40 yaş altı hastalarda moleküler alt tiplerden luminal B ve TN daha fazla görülürken 55 yaş üzeri hastalarda luminal A alt tipi daha fazla görüldü (sırasıyla p<0.001, p=0.001). Sonuç <40 yaş ile 55 yaş ve üzeri hastalar arasında klinikopatolojik farklılıklar doğrulandı. 40 yaşın altındaki hastalarda meme kanseri için olumsuz prognostik faktörler ortaya çıktı.

Anahtar Kelimeler:

Meme Kanseri, Lenfovaskuler invazyon, Lenf nodu metastazı, Moleküler alt tip, Meme yoğunluğu

COMPARISON OF THE EFFECTS OF CLINICOPATHOLOGICAL AND RADIOLOGICAL FINDINGS ON SURVIVAL IN WOMEN YOUNGER THAN 40 YEARS AND OLDER THAN 55 YEARS OF AGE WITH BREAST CANCER

Objective Tumors of women with breast cancer show clinical and biological differences depending on the hormonal changes that develop with age. Therefore, in this study, we compared the radiologic, and clinicopathological features of breast cancer patient’s < 40 age and ≥55 age. Material and Method The files of a total of 759 patients, including 92 patients under 40 aged, and 322 patients 55 aged and over who were operated on for breast cancer over a 10-year period in three centres were retrospectively reviewed and Estrojen Reseptor (ER), Progesteron Reseptor (PR), Human epidermal growth factor receptor 2 (HER2), Lymphovascular invasion (LVI) status, presence of axillary lymph node metastasis (ALNM), multifocality, presence of Ductal Carsinoma İnsitu (DCIS) or Lobular Carsinoma İnsitu (LCIS), tumor size, tumor histopathological type, grade, and score were recorded. Results In patients under the age of 40, the tumor is less localized in the upper-inner and lower-inner quadrants of the breast, multifocality is more common, most of them have dense breast structure, the histological grade of the tumor is higher, LVI and LNM are more common. It was found that they had ER receptor positivity and higher Ki-67 proliferation index (p<0.001, p<0.001, p<0.001, p<0.001, p=0.021, p=0.039, p=0.001 and p<0.001, respectively). It was observed that the multifocality and density of breast tissue were lower in tumors in patients under 55 years of age (p = 0.002, p <0.001, respectively). Luminal B and TN were more common among molecular subtypes in patients under 40 years of age, while luminal A subtype was more common in patients over 55 years of age (p<0.001, p=0.001, respectively). Conclusion Clinicopathological differences between <40 aged, and 55 aged and over patients were confirmed. Adverse prognostic factors for breast cancer at the age of under 40 patients were revealed.

Keywords:

Breast Cancer, lymphovascular invasion, lymph node metastasis, molecular subtype, breast density,

PDF

___

1. Centers for Disease Control and Prevention (CDC). 2020. Breast Cancer Statistics 2017. Retrieved from https://gis.cdc.gov/ Cancer/USCS/DataViz.html.
2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
3. Thorat MA, Balasubramanian R. Breast cancer prevention in high-risk women. Best Pract Res Clin Obstet Gynaecol. 2020;65:18-31.
4. Sun YS, Zhao Z, Yang ZN, Xu F, Lu HJ, Zhu ZY, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13(11):1387-97.
5. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population- based study from the California cancer Registry. Cancer. 2007;109(9):1721-8.
6. Öztürk VS, Polat YD, Soyder A, Tanyeri A, Karaman CZ, Taşkın F. The Relationship Between MRI Findings and Molecular Subtypes in Women With Breast Cancer. Curr Probl Diagn Radiol. 2020;49(6):417-21.
7. Morkavuk ŞB, Güner M, Çulcu S, Eroğlu A, Bayar S, Ünal AE. Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer. Int J Clin Pract. 2020;6:e13897.
8. Pourteimoor V, Mohammadi-Yeganeh S, Paryan M. Breast cancer classification and prognostication through diverse systems along with recent emerging findings in this respect; the dawn of new perspectives in the clinical applications. Tumour Biol. 2016;37(11):14479-99.
9. Tsang JYS, Tse GM. Molecular Classification of Breast Cancer. Adv Anat Pathol. 2020;27(1):27-35.
10. Kocaöz S, Korukluoğlu B, Parlak Ö, Doğan HT, Erdoğan F. Comparison of clinicopathological features and treatments between pre- and postmenopausal female breast cancer patients - a retrospective study. Prz Menopauzalny. 2019;18(2):68-73.
11. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784-95.
12. Sisti A, Huayllani MT, Boczar D, Restrepo DJ, Spaulding AC, Emmanuel G, et al. Breast cancer in women: a descrip- tive analysis of the national cancer database. Acta Biomed. 2020;91(2):332-41.
13. Han Y, Moore JX, Langston M, Fuzzell L, Khan S, Lewis MW, et al. Do breast quadrants explain racial disparities in breast cancer outcomes? Cancer Causes Control. 2019;30(11):1171-82.
14. Sohn VY, Arthurs ZM, Sebesta JA, Brown TA. Primary tumor location impacts breast cancer survival. Am J Surg. 2008;195(5):641-4.
15. Shahar KH, Buchholz TA, Delpassand E, Sahin AA, Ross MI, Ames FC, et al. Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer. 2005;103(7):1323-9.
16. Zhang M, Wu K, Zhang P, Wang M, Bai F, Chen H. Breast-Conserving Surgery is Oncologically Safe for Well-Selected, Centrally Located Breast Cancer. Ann Surg Oncol. 2021;28(1):330-9.
17. Kocic B, Filipovic S, Vrbic V, Pejcic I. Breast cancer in women under 40 years of age. J BUON. 2011;16(4):635-9.
18. Fried G, Kuten A, Dedia S, Borovik R, Robinson E. Experience with conservative therapy in primary breast cancer: experiences Northern Israel Oncology Center, 1981-1990. Harefuah. 1996;130(9):589-93, 654.
19. Foxcroft LM, Evans EB, Porter AJ. The diagnosis of breast cancer in women younger than 40. Breast. 2004;13(4):297-306.
20. Appleton DC, Hackney L, Narayanan S. Ultrasonography alone for diagnosis of breast cancer in women under 40. Ann R Coll Surg Engl. 2014;96(3):202-6.
21. Durhan G, Azizova A, Önder Ö, Kösemehmetoğlu K, Karakaya J, Akpınar MG, et al. Imaging Findings and Clinicopathological Correlation of Breast Cancer in Women under 40 Years Old. Eur J Breast Health. 2019;15(3):147-52.
22. Muttarak M, Pojchamarnwiputh S, Chaiwun B. Breast cancer in women under 40 years: preoperative detection by mammography. Ann Acad Med Singap. 2003;32(4):433-7.
23. Schnejder-Wilk A. Breast cancer imaging: Mammography among women of up to 45 years. Pol J Radiol. 2010;75(1):37- 42.
24. Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The relationship of mammographic density and age: implications for breast cancer screening. AJR Am J Roentgenol. 2012;198(3):W292-5.
25. Liao YS, Zhang JY, Hsu YC, Hong MX, Lee LW. Age-Specific Breast Density Changes in Taiwanese Women: A Cross-Sectional Study. Int J Environ Res Public Health. 2020;17(9):3186.
26. Erić I, Petek Erić A, Koprivčić I, Babić M, Pačarić S, Trogrlić B. Independent factors FOR poor prognosis in young patients with stage I-III breast cancer. Acta Clin Croat. 2020;59(2):242-51.
27. Bakkach J, Mansouri M, Derkaoui T, Loudiyi A, Fihri M, Hassani S, et al. Clinicopathologic and prognostic features of breast cancer in young women: a series from North of Morocco. BMC Womens Health. 2017;17(1):106.
28. Tvedskov TF, Jensen MB, Lisse IM, Ejlertsen B, Balslev E, Kroman N. High risk of non-sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node. Int J Cancer. 2012;131(10):2367-75.
29. Eugênio DS, Souza JA, Chojniak R, Bitencourt AG, Graziano L, Souza EF. Breast cancer features in women under the age of 40 years. Rev Assoc Med Bras (1992). 2016;62(8):755-61.
30. Wang JM, Wang J, Zhao HG, Liu TT, Wang FY. Reproductive Risk Factors Associated with Breast Cancer Molecular Subtypes among Young Women in Northern China. Biomed Res Int. 2020;2020:5931529.
31. Erić I, Petek Erić A, Kristek J, Koprivčić I, Babić M. Breast cancer in young women: pathologic and immunohistochemical features. Acta Clin Croat. 2018;57(3):497-502.
32. Han W, Kim SW, Park IA, Kang D, Kim SW, Youn YK, et al. Young age: an independent risk factor for disease-free survival in women with operable breast cancer. BMC Cancer. 2004;4:82.