Young age at diagnosis is associated with worse prognosis in the Luminal A breast cancer subtype: a retrospective institutional cohort study
Although age is a recognized independent prognostic risk factor, its relative importance among molecular subtypes of Breast cancer (BCA) is not well documented. The aim of this study was to evaluate the prognostic role of age at diagnosis among different immunohistochemical subtypes of BCA.
We conducted a retrospective study of women with invasive BCA undergoing surgery at the Johns Hopkins Hospital, excluding patients presenting with stage IV breast cancer. Patients were stratified into three age groups: ≤ 40, 41–60, and > 60 years, and multivariable analysis was performed using Cox regression. We also identified differentially expressed genes (DEG) between age groups among BCA subtypes in the public TCGA dataset. Finally, we identified key driver genes within the DEGs using a weighted gene co-expression network analysis.
Luminal A breast cancer patients had significantly lower 5 year disease-free survival (DFS) and distant metastasis-free survival (DMFS) in the ≤ 40 year age group compared to the 41–60 year age group, while the other molecular subtypes showed no significant association of DFS or DMFS with age. Age was a stronger outcome predictor than tumor grade or proliferative index in Luminal A BCA patients, but not other subtypes. BCA TCGA gene expression data were divided into two groups (≤ 40 years, > 40 years). We identified 374 DEGs in the Luminal A BCA subset, which were enriched in seven pathways and two modules of co-expressed genes. No age group-specific DEGs were identified in non-Luminal A subtypes.
Age at diagnosis may be an important prognostic factor in Luminal A BCA.
KeywordsBreast cancer Intrinsic subtype Age Prognosis Gene expression
Differentially expressed genes
Disease free survival
Distant metastasis-free survival
Human epidermal growth factor receptor 2
Gene set enrichment analysis
Variable importance score
Weighted gene co-expression network analysis
Oncotype DX recurrence score
Gene expression classification
Epithelial to mesenchymal transition
Transforming growth factor
G protein subunit alpha 13
We would like to thank all who participated in the annotation of the JH Integrated Breast Cancer Database that made this study possible.
All authors participated in the design and planning of the project and in writing the manuscript.
This work was supported, in part, by a DOD Grant (W81XWH-14-1-0080) to CBU and by funding from the Qingdao Municipal Hospital, China to ZL. Funding had no role in the design of the study nor in collection, analysis, and interpretation of data or in writing the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For the institutional cohorts, de-identified data were extracted from the Johns Hopkins Institutional Review Board-approved Integrated Breast Cancer Database (NA00022703). This article does not contain any studies with human participants performed by any of the authors.
For this type of study formal consent is not required.
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