Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester, UK.
Breast Cancer Res Treat. 2013 Jul;140(1):135-42. doi: 10.1007/s10549-013-2583-1. Epub 2013 Jun 20.
BRCA1/2 mutation carriers with breast cancer are at high risk of contralateral disease. Such women often elect to have contralateral risk-reducing mastectomy (CRRM) to reduce the likelihood of recurrence. This study considers whether CRRM improves overall survival. 105 female BRCA1/2 mutation carriers with unilateral breast cancer who underwent CRRM were compared to controls (593 mutation carriers and 105 specifically matched) not undergoing CRRM and diagnosed between 1985 and 2010. Survival was assessed by proportional hazards models, and extended to a matched analysis using stratification by risk-reducing bilateral salpingo-oophorectomy (RRBSO), gene, grade and stage. Median time to CRRM was 1.1 years after the primary diagnosis (range 0.0-13.3). Median follow-up was 9.7 years in the CRRM group and 8.6 in the non-CRRM group. The 10-year overall survival was 89 % in women electing for CRRM (n = 105) compared to 71 % in the non-CRRM group (n = 593); p < 0.001. The survival advantage remained after matching for oophorectomy, gene, grade and stage: HR 0.37 (0.17-0.80, p = 0.008)-CRRM appeared to act independently of RRBSO. CRRM appears to confer a survival advantage. If this finding is confirmed in a larger series it should form part of the counselling procedure at diagnosis of the primary tumour. The indication for CRRM in women who have had RRBSO also requires further research.
BRCA1/2 突变携带者患有乳腺癌，其对侧疾病的风险很高。这些女性通常选择进行对侧降低风险的乳房切除术（CRRM），以降低复发的可能性。本研究考虑了 CRRM 是否能提高总生存率。105 名单侧乳腺癌 BRCA1/2 突变携带者接受了 CRRM，与未接受 CRRM 的对照组（593 名突变携带者和 105 名特定匹配的携带者）进行了比较，这些对照组在 1985 年至 2010 年间被诊断出来。使用比例风险模型评估生存情况，并使用风险降低双侧输卵管卵巢切除术（RRBSO）、基因、分级和分期分层进行匹配分析进行扩展。CRRM 的中位时间是在原发诊断后 1.1 年（范围 0.0-13.3）。CRRM 组的中位随访时间为 9.7 年，非 CRRM 组为 8.6 年。选择进行 CRRM 的 10 年总生存率为 89%（n=105），而非 CRRM 组为 71%（n=593）；p<0.001。在匹配卵巢切除术、基因、分级和分期后，生存优势仍然存在：HR 0.37（0.17-0.80，p=0.008）-CRRM 似乎独立于 RRBSO 发挥作用。CRRM 似乎带来了生存优势。如果这一发现在更大的系列中得到证实，它应该成为原发性肿瘤诊断时咨询程序的一部分。已经进行 RRBSO 的女性进行 CRRM 的适应症也需要进一步研究。
