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Poor Outcome of Hormone Receptor–Positive Breast Cancer at Very Young Age Is Due to Tamoxifen Resistance: Nationwide Survival Data in Korea—A Report From the Korean Breast Cancer Society

 Sei Hyun Ahn  ;  Byung Ho Son  ;  Wonshik Han  ;  Seung-Sang Ko  ;  Joon Jeong  ;  Seung Il Kim  ;  Seok Won Kim 
 JOURNAL OF CLINICAL ONCOLOGY, Vol.25(17) : 2360-2368, 2007 
Journal Title
Issue Date
Adult ; Age Factors ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Breast Neoplasms/drug therapy ; Breast Neoplasms/metabolism ; Breast Neoplasms/mortality* ; Drug Resistance, Neoplasm* ; Female ; Humans ; Korea ; Middle Aged ; Prognosis ; Receptors, Estrogen/metabolism* ; Receptors, Progesterone/metabolism* ; Registries ; Selective Estrogen Receptor Modulators/therapeutic use ; Tamoxifen/therapeutic use*
PURPOSE: Breast cancer in very young women (age < 35 years) is uncommon and poorly understood. We sought to evaluate the prognosis and treatment response of these patients compared with women ages 35 to 50 years. PATIENTS AND METHODS: We analyzed data from 9,885 breast cancer patients age < or = 50 years who were part of the Korean Breast Cancer Society registration program between 1992 and 2001. The overall survival (OS) and breast cancer-specific survival (BCSS) were compared between age groups. RESULTS: One thousand four hundred forty-four patients (14.6%) were younger than age 35 and 8,441 (85.4%) patients were between 35 and 50 years of age. Younger patients had significantly higher T-stage and higher lymph node positivity and lower hormone receptor expression than older patients. Younger patients had a greater probability of death than older patients, regardless of tumor size or lymph node status. The survival difference was significant for patients with positive or unknown hormone receptor status (P < .0001), but not for patients with negative hormone receptor status. In a multivariate analysis, the interaction term of young age and hormone receptor positivity was significant for OS and BCSS with a hazard ratio for OS of 2.13 (95% CI, 1.52 to 2.98). The significant survival benefit from adjuvant hormone therapy after chemotherapy observed in older patients (hazard ratio for OS, 0.61; 95% CI, 0.47 to 0.79; P = .001) could not be seen in younger patients (P > .05). CONCLUSION: Younger patients (age < 35) showed worse prognosis than older patients (age, 35 to 50 years) only in the hormone receptor-unknown or hormone receptor-positive subgroups. Adjuvant tamoxifen therapy might provide less survival benefit when added to chemotherapy in very young breast cancer patients.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Seung Sang(고승상)
Kim, Seung Il(김승일)
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
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