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Clinical and histopathological differences between premenopausal and postmenopausal ER+ breast cancer
20 September 2018 (online)
In comparison to postmenopausal women (postM), breast cancer in premenopausal women (preM) is frequently associated with worse prognosis and there is evidence that preM estrogen receptor-positive (ER+) tumors may respond poorly to endocrine therapy. Aim of this retrospective study was to analyze histopathological and clinical characteristics in preM and postM ER+ breast cancer patients.
Between 2012 and 2017 clinical and pathological data of 4940 patients with ER+ breast cancer (1890 preM, 46.7 ± 5.3y; 3050 postM, 61.4 ± 8y) were documented during oncologic indoor-rehabilitation in the Paracelsus Hospital in Scheidegg.
In 4606 cases (93.2%) tumor stage aT1/2 were noted, whereas in 334 cases (6.8%) an advanced tumor stage (T3/4) was documented. PreM ER+ breast cancer was significantly more often associated with Her2neu positive receptor status (17.4 vs. 13.2%; P < 0.0001), higher proliferative capacity (Ki67 23.4 ± 19.3 vs. 15.6 ± 16.6; P < 0.0001), positive lymph node involvement (N+ 40.0 vs. 31.3%; P < 0.0001) and more often a poor tumor differentiation (G3 27.7 vs. 21.3%; P < 0.0001). In ER+ preM, double cancer occurs more frequently (P = 0.01) whereas histological subtype of lobular carcinoma (12.9 vs. 17.9%; P < 0.0001) was less common and treatment with chemotherapy (61.3 vs. 37.7%; P < 0.0001) and mastectomy (27 vs. 20.6%; P < 0.0001) was performed more often.
In comparison to postM ER+ breast cancer tumors in preM showed more aggressive tumor biology and advanced tumor stage. Additionally studies are needed to elucidate the distinct molecular pathways in preM and postM ER+ breast cancer.