Breast Surgery Department, European Institute of Oncology, Milan, Italy.
Ann Surg Oncol. 2009 Dec;16(12):3380-7. doi: 10.1245/s10434-009-0638-7.
Approximately 10% of patients with breast cancer who are treated with breast-conserving surgery (BCS) develop an ipsilateral-breast tumor recurrence (IBTR). The optimal local therapy for women with BRCA-associated breast carcinoma remains controversial. We report the outcome of BCS in BRCA mutation carriers followed at a single institution.
A total of 54 women with BRCA1/2-associated breast cancer treated with BCS and whole breast radiotherapy were matched for age, tumor size, and time of surgery with 162 patients with sporadic breast cancer who had the same treatment between February 1994 and October 2007. Primary end points were cumulative incidence of IBTR and contralateral breast cancer (CBC). Median follow-up was 4 years for both groups.
Median age was 36 and 37 years for mutation carriers and controls, respectively; mean tumor size was 1.8 cm in carriers and 1.9 cm in controls. Ten-year cumulative incidence of IBTR was 27% for mutation carriers and 4% for sporadic controls (hazard ratio 3.9; 95% confidence interval 1.1-13.8; P = 0.03). Ten-year cumulative incidence of CBC was 25% for mutation carriers and 1% for sporadic controls (P = 0.03).
Our data suggest that IBTR risk after BCS in BRCA1/2 mutation carriers is increased compared with patients who have sporadic breast cancer. Likewise, the risk of CBC seems to be increased in this group. These risks and the likelihood of developing new primary tumors should be discussed with carriers interested in breast conservation as well as when choosing risk-reducing strategies.
约 10%接受保乳手术（BCS）治疗的乳腺癌患者会出现同侧乳房肿瘤复发（IBTR）。BRCA 相关性乳腺癌患者的最佳局部治疗仍存在争议。我们报告了在一家机构接受治疗的 BRCA 突变携带者接受 BCS 的结果。
共有 54 名接受 BRCA1/2 相关乳腺癌治疗的 BCS 和全乳放疗的 BRCA 突变携带者与 162 名接受相同治疗的散发性乳腺癌患者相匹配，这些患者在 1994 年 2 月至 2007 年 10 月期间接受了治疗。主要终点是 IBTR 和对侧乳腺癌（CBC）的累积发生率。两组的中位随访时间均为 4 年。
突变携带者和对照组的中位年龄分别为 36 岁和 37 岁；携带者的平均肿瘤大小为 1.8 厘米，对照组为 1.9 厘米。携带者 10 年 IBTR 的累积发生率为 27%，散发性对照组为 4%（风险比 3.9；95%置信区间 1.1-13.8；P = 0.03）。携带者 10 年 CBC 的累积发生率为 25%，散发性对照组为 1%（P = 0.03）。
我们的数据表明，与患有散发性乳腺癌的患者相比，BRCA1/2 突变携带者接受 BCS 后的 IBTR 风险增加。同样，该组中 CBC 的风险似乎也增加了。在考虑保乳以及选择降低风险的策略时，应与有兴趣保乳的携带者讨论这些风险以及发生新原发性肿瘤的可能性。
