研究极年轻乳腺癌患者生育相关问题关注度的影响因素，并分析其预后。

收集2009年12月至2019年1月经河北医科大学第四医院乳腺中心诊治、年龄≤25岁且有完整临床病理资料的50例极年轻乳腺癌女性患者进行回顾性研究。所有患者均完成了生育问题和结果量表(FIS)。采用单因素和多因素Logistic回归模型评估社会人口统计学因素、肿瘤因素与生育相关问题关注度之间的关系；采用Kaplan-Meier方法进行患者生存分析，用log-rank检验进行组间比较，采用Cox比例风险回归模型探讨影响极年轻乳腺癌患者预后的因素。

50例极年轻乳腺癌患者中，36例患者与其主管医师在确诊后/治疗前未沟通生育相关问题，仅有14例患者在确诊后/治疗前沟通过；28例患者表示乳腺癌治疗后仍有生育愿望；11例患者在治疗结束后妊娠，占全部患者的22%(11/50)，其中，有6例患者在未咨询医师的情况下，自行选择人工流产，其余5例患者均足月妊娠，新生儿健康。单因素和多因素Logistic回归分析显示确诊前生育状态是极年轻乳腺癌患者生育相关问题关注度的独立影响因素(单因素分析：OR＝0.250, 95%CI: 0.070～0.897, P＝0.033；多因素分析：OR＝0.270，95%CI：0.048～0.901，P＝0.035)。50例患者中共有9例(18%)患者复发或转移，其中，7例(14%)患者死亡，原因与乳腺癌直接相关。单因素分析显示：诊断延迟时间是极年轻乳腺癌患者DFS和OS的影响因素(χ²＝8.857、6.928，P＝0.003、0.008)，病理类型是患者DFS的影响因素(χ²＝4.824，P＝0.028)，但不是OS的影响因素(χ²＝3.339，P＝0.069)。多因素分析结果显示：诊断延迟时间是患者DFS的独立预后因素(HR＝13.121，95%CI：1.385～124.348，P＝0.025)。生存分析结果显示：诊断延迟时间>3个月组与诊断延迟时间≤3个月组比较，患者的DFS差异有统计学意义(χ²＝4.834，P＝0.025)，而OS差异无统计学意义(χ²＝1.035，P＝0.311)。

治疗前未生育的患者对生育相关问题关注度高。诊断延迟可能导致极年轻乳腺癌患者的预后变差，值得临床医师关注。

To explore the factors that affect the awareness of fertility-related issues in very young breast cancer patients and analyze the prognostic factors.

This retrospective study involved 50 very young female breast cancer patients (≤25 years) with complete clinicopathological data in the Breast Disease Center, the Fourth Hospital of Hebei Medical University from December 2009 to January 2019. All patients completed the Fertility Issues and Outcomes Scale (FIS). Univariate and multivariate Logistic regression models were used to evaluate the relationship between sociodemographic factors, tumor factors and awareness of fertility-related issues. Kaplan-Meier method was used for survival analysis and log-rank test was used for comparison between groups. The Cox proportional hazards regression model was used to explore the factors that affect the prognosis of very young breast cancer patients.

Among 50 very young breast cancer patients, 36 patients had not communicated with their doctors on fertility-related issues after diagnosis or before treatment, and only 14 patients had discussed about those issues; 28 patients expressed their wills to have children after treatment; 11 patients had pregnancy after breast cancer treatment, accounting for 22% (11/50) of all patients. Among them, 6 patients had abortions without counselling their doctors and other five patients had healthy newborns after full-term pregnancy. The univariate and multivariate Logistic regression analyses showed that the fertility status before diagnosis was an independent factor affecting the awareness of fertility-related issues in very young breast cancer patients (univariate: OR=0.250, 95%CI: 0.070-0.897, P=0.033; multivariate: OR=0.270, 95%CI: 0.048-0.901, P=0.035). Nine patients (18%, 9/50) had recurrence or metastasis, including seven breast cancer-related deaths (14%, 7/50). Univariate analysis showed that diagnosis delay time was an influencing factor of DFS and OS (χ²=8.857, 6.928, P=0.003, 0.008), and pathological type was an influencing factor of DFS (χ²=4.824, P=0.028), but not an influencing factor of OS (χ²=3.339, P=0.069). The results of multivariate analysis showed that diagnosis delay time was an independent prognostic factor of DFS (HR=13.121, 95%CI: 1.385-124.348, P=0.025) in very young breast cancer patients. The survival analysis showed that the patients with delayed diagnosis > 3 months had worse DFS compared with patients with delayed diagnosis≤3 months (χ²=4.834, P=0.025), but OS presented no significant difference (χ²=1.035, P=0.311).

The breast cancer patients who have not given birth before treatment are highly concerned about fertility-related issues. The delayed diagnosis may lead to poor prognosis in very young breast cancer patients, which deserves special attention of clinicians.