我国轻乳腺癌的发病特点和治疗策略讲义.pptVIP

妊娠哺乳期乳腺癌的治疗策略 定义：妊娠期或产后1年内确诊的乳腺癌 发生率：占所有乳腺癌的0.2%～3.8% 发生年龄：70%发生在30岁以下 我院129例30岁以下乳腺癌中，妊娠哺乳期乳腺癌占24.8% 病理特点：最常见的病理类型是浸润性导管癌，大部分肿瘤分化差，常伴有脉管瘤栓 预后：一般认为较差 王中华，徐兵河. 中华肿瘤杂志, 2005, 27(2): 111-113 何为年轻乳腺癌？ 年龄 ≤30岁 ≤35岁 ≤40岁～50岁 各年龄组乳腺癌发病率及死亡率 Ries LAG, Melbert D, et al. SEER Cancer Statistics Review, 1975-2005, National Cancer Institute. Bethesda, MD, /csr/1975_2005/, based on November 2007 SEER data submission, posted to the SEER web site, 2008. 50岁以下乳腺癌发病率 Jeong KK, Beom SK, Jung SL, et al. Do Very Young Korean Breast Cancer Patients Have Worse Outcoms? Annals of Surgical Oncology, 2007.14(12): 3385－91 Breast Cancer in Young Asian Women Agarwal G, et al. World J Surg. 2007;31:1031–.1040. 10 – 14 yr 15 – 19 yr 20 – 24 yr 25 – 29 yr 30 – 34 yr Pakistan (1995 – 1997) — 1.2 6.3 14.0 48.4 Israel (Jews) 0.1 0.2 2.1 9.7 33.3 Singapore — — — 6.3 29.9 Egypt — 0 1.4 8.5 29.9 Bahrain — 0 0 0 27.7 China (Beijing; 1993 – 1997) — 0.7 3 11 26.9 Kuwait — 0 0 2.9 22.7 Philippines (Manila) 0.1 0.5 1.9 8.2 22.1 Jordan — 0 0.8 6.5 21.7 Mali 0.5 1.9 2.9 8.5 21.7 Oman — 1.9 2.9 8.5 21.7 Korea (Seoul) — 0.3 1.5 6.1 17.3 Japan (Nagasaki) — 0.4 1.8 3.1 16 Thailand — 0.4 1.2 4.8 15.2 Vietnam — 0.9 7.6 11.5 13.8 Number of new breast cancer patients diagnosed per 100,000 of the young populations in Asian countries 中国乳腺癌的发病特点 Higher Percentage of young patients than in Western countries 50% of patients are premenopausal Higher percentage of ER negative patients than in Western countries 40%-50% are ER negative Fan L et al., Breast cancer Res Treat. 2009 发病机制 性激素水平异常，缺乏运动，高脂饮食，肥胖，酗酒，杀虫剂等化学物及射线的接触，等等 基因异常：BRCA-1、BRCA-2等基因突变 多篇文献报导：与老年乳腺癌相比，年轻乳腺癌病人的预后更差，年龄是一个独立的危险因素 [1,2] St. Gallen 会议专家共识认为：年龄小于35岁是淋巴结阴性乳腺癌病人复发风险的预测指标之一。 年龄是否是独立的预后因素？ 1.Jeong KK, Beom SK, Jung SL, et al. Do Very Young Korean Breast Cancer Patients Have Worse Outcoms? Annals of Surgical Oncology, 2007.14(12): 3385－91 2.Han W, Kim SW, Park LA, et al. Young age: an independent risk factor for disease-free surv