| Abstract | CILJ ISTRAŽIVANJA: Osnovni cilj ovog istraživanja bio je usporediti osobitosti tumora dojke kao što su: veličina tumora, fokalnost, bilatralnost, histološki tip, histološki gradus, imunofenotip, klinički stadij, te način liječenja ovisno o dobnim skupinama.
ISPITANICI I METODE: U studiju su uključeni bolesnici kojima je karcinom dojke dijagnosticiran u Republici Hrvatskoj u razdoblju od 01. 01. 2017. do 31. 12. 2017. godine. Uvidom u medicinsku dokumentaciju KBC-a Split, Klinike za tumore Zagreb, KBC-a Zagreb, KBC-a Rijeka, KBC-a Osijek, KB Dubrava, OB Zadar, OB Šibenik, OB Pula, ŽB Čakovec, OB Slavonski Brod, Poliklinike Edumed, Poliklinike Eljuga, OB Našice i OB Knin analizirani su podaci o dobi bolesnika, veličini tumora, histološkom tipu, gradusu, fokalnosti, statusu hormonskih receptora, HER2 statusu, proliferacijskom indeksu, imunofenotipu, kliničkom stadiju, te primijenjenom kirurškom i onkološkom liječenju. Za usporedbu kvantitativnih podataka između istraživanih skupina korišteni su T-test, Mann-Whitney U test, Kruskal-Wallis test ovisno o broju skupina i raspodjeli kvantitativne varijable. Za utvrđivanje povezanosti dvaju kvalitativnih varijabli korišten je hi-kvadrat test.
REZULTATI: U 2017. godini u Republici Hrvatskoj registrirano je 2613 oboljelih od karcinoma dojke (98,8% žena i 1,2% muškaraca). Stopa incidencije oboljelih od karcinoma dojke životne dobi od 20 do 95 godina u RH u 2017. godini iznosi 77,1 na 100 000 stanovnika. Stopa incidencije za žene oboljele od karcinoma dojke u RH u 2017. godini iznosi 145 na 100 000 žena. Od ukupnog broja žena s karcinomom dojke, najveći broj žena (28,6%) bilo je u dobnoj skupini od 60 do 69 godina, a žene mlađe životne dobi (dobne skupine od 20-29, od 30-39 godina) činile su 5,2% ukupnog broja oboljelih. Stopa incidencije za muškarace oboljele od karcinoma dojke životne dobi od 20 do 95 godina u RH u 2017. godini iznosi 0,193 na 100 000 muškaraca. Od ukupnog broja muškaraca s karcinomom dojke, 61% bilo je u dobnoj skupini od 60-69 godina, a muškarci mlađe životne dobi (dobne skupine od 20-29, od 30-39 godina) činili su 3,2% ukupnog broja oboljelih. Postoji značajna razlika vrste liječenja u odnosu na dobne skupine (χ2=82,3; P<0,001), te je udio bolesnica mlađih od 30 godina za 2,7 puta veći u skupini neoadjuvantno liječenih, u odnosu na kompletno operirane. Medijan životne dobi u skupini tumora liječenih neoadjuvantno je za 6 godina manji nego u skupini tumora koji su liječeni operacijom (P<0,001) i za 7,5 godina je manji u odnosu na inicijalno metastatske tumore (P<0,001). Medijan veličine tumora bio je značajno veći u bolesnica starijih dobnih skupina (60-69 godina i ≥70 godina) u odnosu na bolesnice mlađe životne dobi (<30 godina, 30-39 godina) (χ2=107,7; ղ2=0,058; P<0,001). Postoji statistički značajna razlika u distribuciji dobnih skupina u odnosu na fokalnost (χ2=24,00; P<0,001), te je značajno veći broj bolesnica mlađe životne dobi (dobne skupine <30 godina, 30-39 godina) bio u skupini multifokalnih tumora. Medijan životne dobi u skupini difuzno infiltrirajućih tumora je za 9 godina veći od medijana dobi kod multifokalnih tumora (P=0,004), a za 7 godina je veći od medijana solitarnih tumora (P=0,039). Postoji statistički značajna povezanost imunofenotipa tumora s dobi bolesnica (χ2=16,7; ղ2=0,013; P=0,002) i s dobnim skupinama (χ2=44,15; P=0,001). Medijan životne dobi u bolesnica s luminalnim B/HER2 pozitivnim tumorima je za 6 godina manji u odnosu na tumore luminalnog A i luminalnog B imunofenotipa. Postoji statistički značajna povezanost dobi s kliničkim stadijem tumora (χ2=55; ղ2=0,031; P<0,001). Medijan dobi bolesnica u kliničkom stadiju IV je za 8 godina veći u odnosu na klinički stadij II (P<0,001) i za 6 godina veći nego u kliničkom stadiju III (P=0,046). Razdioba bolesnica prema dobnim skupinama razlikuje se u odnosu na klinički stadij. Za 4,7 puta je veći udio bolesnica dobne skupine >70 godina u kliničkom stadiju IV nego u kliničkom stadiju I, dok je udio bolesnica dobne skupine 30-39 godina za 3,9 puta veći u kliničkom stadiju I nego u kliničkom stadiju IV. Nije dokazana statistički značajna razlika između bolesnica mlađe i starije životne dobi u odnosu na bilateralnost (χ2=3,99; P=0,550), gradus (χ2=3,1; P=0,216) i histološki tip tumora (χ2=5,2; P=0,074).
ZAKLJUČCI: Najveći broj žena s karcinomom dojke dijagnosticiranim u Republici Hrvatskoj u 2017. godini nalazio se u dobnoj skupini od 60 do 69 godina. U bolesnica mlađe životne dobi, koje su činile su 5,2% ukupnog broja žena, zabilježen je značajno veći broj mutifokalnih tumora, te su češće neoadjuvantno liječene, u odnosu na pacijentice starije životne dobi kod kojih je značajno veći udio bio kompletno operiran. U bolesnica starije životne dobi zabilježen je značajno veći dijametar tumora, te veći udio tumora visokog kliničkog stadija. Karcinomi dojke koji su dijagnosticirani u mlađoj životnoj dobi poseban su biološki entitet, često zahtijevaju agresivnije liječenje, te sveobuhvatan pristup uz sudjelovanje liječnika različitih specijalnosti – radiologa, kirurga, patologa, onkologa, ginekologa, te genetičara. |
| Abstract (english) | OBJECTIVES: The main purpose of this study was to compare clinic-pathological characteristics of breast tumors such as: tumor size, focality, bilaterality, histological type, histological grade, immunophenotype, clinical stage and treatment in correlation to patient's age.
PATIENTS AND METHODS: The study included patients diagnosed with breast cancer in Croatia in the period from 01.01.2017. till 31.12.2017. Clinical data was obtained from the medical documentation of CHC Split, Clinic for Tumors Zagreb, CHC Zagreb, CHC Rijeka, CHC Osijek, CHC Sestre milosrdnice, CH Dubrava, GH Zadar, GH Sibenik, GH Pula, CH Čakovec, GH Slavonski Brod, Polyclynic Edumed and Eljuga, GH Nasice and GH Knin on regarding the patient age, tumor size, histological type, tumor grade, focality, bilaterality, hormone receptor status, HER2 status, proliferation index, immunophenotype, clinical stage and the surgical and oncological treatment. For comparison of quantitative data between the investigated groups T-test, Mann-Whitney, U test, Kruskal-Wallis test were used, depending on the number of groups and the distribution of quantitative variables. To establish the correlation between the two qualitative variables, the Chi-square test was used.
RESULTS: In Croatia 2613 cancer patients (98,8% of women and 1,2% of men) were registered in 2017. The incidence rate of breast cancer in the age groups from 20 to 95 years in Croatia in 2017 was 77,1 per 100 000 inhabitants. The incidence rate of women with breast cancer was 145 per 100 000 women. Most of the women with breast cancer (28,6%) were in the age group from 60 to 69 years and there was 5,2% of young women (age groups 20-29, 30-39 years). Incidence rate of male breast cancer in patients from 20 to 95 years old in Croatia in 2017 was 0,193 per 100 000 males, 61% were in the age group from 60 to 69 years and there was 3,2% of young men (age groups 20-29, 30-39 years). There was statistically significant difference in the type of treatment compared to the age groups (χ2=82,3; P<0,001). The proportion of patients younger than 30 years was 2,7 times higher in the neoadjuvantly treated group than in completely surgically operated patients. Median age of the patients in the neoadjuvantly treated group was 6 years lower than group treated with surgery (P<0,001), and was 7,5 years lower than the initial metastatic tumor group (P<0,001). The median tumor size was significantly higher in patients in older age groups (60-69 years, ≥70 years) compared to younger patients (<30 years, 30-39 years) (χ2=107,7; ղ2=0,058; P<0,001). There was a statistically significant difference in the distribution of age groups in relation to focality with the higher number of younger patients (<30 years, 30-39 years) in the group of multifocal tumors. Median age in the group of diffuse infiltrating tumors was 9 years higher than median age in multifocal tumor groups (P=0,004), and 7 years higher than median age of solitary tumor group (P=0,039). There was a statistically significant association of tumor immunophenotype with age (χ2=16,7; ղ2=0,013; P=0,002) and the age groups (χ2=44,15; P=0,001). Median age of patients with luminal B/HER2 positive tumors was 6 years lower than in luminal A and luminal B tumors. There was statistically significant correlation of age with clinical stage (χ2=55; ղ2=0,031; P<0,001). Median age of patients in clinical stage IV was 8 years higher than clinical stage II (P<0,001) and 6 years higher than clinical stage III (P=0,046). The distribution of patients by age group differs regarding the clinical stage. There was 4,7 times greater proportion of patients in the age group >70 years in clinical stage IV than in clinical stage I, while the share of patients in the age group from 30 to 39 years was 3,9 times higher in clinical stage I than in clinical stage IV. There was no statistically significant difference between the young and the eldery patients regarding the bilaterality (χ2=3,99; P=0,550), grade (χ2=3,1; P=0,216) and histological type of tumor (χ2=5,2; P=0,074).
CONCLUSION: The greatest proportion of women with breast cancer diagnosed in Croatia in 2017 were in the age group from 60 to 69 years. In young patients, which counted 5,2% of the total number of women with breast cancer, higher number of multifocal tumors was diagnosed. Young patients were more often treated with neoadjuvant therapy, compared to older patients, who were more likely surgically treated. Tumors with larger diameter and higher clinical stage were more often diagnosed in older patients. Breast cancer diagnosed in young adults is a special biological entity, which often require more aggressive treatment and a comprehensive approach that includes doctors of various specializations-radiologist, surgeon, pathologist, oncologists, gynecologists and geneticists. |
