Department of Surgery, Division of Surgical Oncology at Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2012 Aug;19(8):2600-6. doi: 10.1245/s10434-012-2299-1. Epub 2012 Mar 7.
There has been an increasing trend toward contralateral prophylactic mastectomy (CPM) in the management of breast cancer (BCa). This study's objective was to compare clinicopathologic characteristics of BCa patients who elected CPM to those who elected unilateral total mastectomy (UTM) and to determine whether CPM improved survival.
Comparison was performed on 355 patients with stage 0-III BCa matched by age and stage who underwent mastectomy from 1995 to 2008: 177 patients had CPM; 178 patients had UTM. Clinicopathological characteristics and survival outcomes were analyzed.
Women who underwent preoperative MRI were twice as likely to have CPM (40.9 vs. 19.7%, P < 0.001). MRI identified additional suspicious foci in 45% CPM and 19% UTM. Patients with history of previous breast biopsies, family history, or BRCA mutation were more likely to choose CPM than UTM (40.1 vs. 24%, P = 0.001; 64.3 vs. 41.4%, P < 0.001; 20.3 vs. 6.5%, P = 0.04, respectively). CPM patients elected nipple preservation (26 vs. 5.2%, P < 0.001) and immediate reconstruction more often (92.2 vs. 73.5%, P < 0.001); UTM patients were more likely to have attempted breast conservation prior to mastectomy (52.8 vs. 39.5%, P = 0.01). CPM identified occult BCa in 11 patients (6.6%), and three UTM patients (1.7%) developed contralateral BCa. With median follow-up of 61 months, by univariable/multivariable analyses, CPM did not improve overall, disease-free, or distant metastases-free survival.
Factors that may influence choice of CPM included preoperative MRI, history of prior breast biopsies, immediate reconstruction, nipple preservation, family history, and BRCA status. Those who chose CPM did not have improved survival.
在乳腺癌（BCa）的治疗中，对侧预防性乳房切除术（CPM）的趋势不断增加。本研究的目的是比较选择 CPM 的 BCa 患者与选择单侧全乳房切除术（UTM）的患者的临床病理特征，并确定 CPM 是否改善了生存。
比较了 1995 年至 2008 年期间接受乳房切除术的 355 名 0-III 期 BCa 患者，这些患者按年龄和分期匹配：177 名患者接受 CPM；178 名患者接受 UTM。分析了临床病理特征和生存结果。
接受术前 MRI 的女性进行 CPM 的可能性是 UTM 的两倍（40.9%比 19.7%，P < 0.001）。MRI 在 45%的 CPM 和 19%的 UTM 中发现了额外的可疑病灶。有既往乳腺活检史、家族史或 BRCA 突变史的患者更倾向于选择 CPM 而不是 UTM（40.1%比 24%，P = 0.001；64.3%比 41.4%，P < 0.001；20.3%比 6.5%，P = 0.04）。CPM 患者选择保留乳头（26%比 5.2%，P < 0.001）和立即重建的比例更高（92.2%比 73.5%，P < 0.001）；UTM 患者更有可能在乳房切除术前尝试保留乳房（52.8%比 39.5%，P = 0.01）。CPM 发现 11 例（6.6%）隐匿性 BCa，3 例 UTM 患者（1.7%）发生对侧 BCa。中位随访 61 个月，单变量/多变量分析显示，CPM 并未改善总体、无疾病或无远处转移生存。
可能影响 CPM 选择的因素包括术前 MRI、既往乳腺活检史、即刻重建、保留乳头、家族史和 BRCA 状态。选择 CPM 的患者并未获得改善的生存。
