Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.
Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
J Clin Oncol. 2020 Sep 10;38(26):3012-3023. doi: 10.1200/JCO.19.02399. Epub 2020 Jul 16.
Young women with germline mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline mutations.
This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors.
Of 1,252 patients with germline mutations (, 811 patients; , 430 patients; , 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; = .66) were observed between the pregnancy and nonpregnancy cohorts.
Pregnancy after breast cancer in patients with germline mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with -mutated breast cancer interested in future fertility.
携带种系突变的年轻女性面临独特的生殖挑战。乳腺癌后的妊娠并不会增加复发风险；然而，携带 突变的患者仅有非常有限的数据。本研究旨在调查妊娠对携带种系 突变的患者乳腺癌结局的影响。
这是一项国际性、多中心、基于医院的回顾性队列研究。符合条件的患者于 2000 年 1 月至 2012 年 12 月期间在 40 岁以下被诊断为浸润性早期乳腺癌，携带有害的种系 突变。主要终点为乳腺癌后妊娠患者与非妊娠患者的妊娠率和无病生存（DFS）。次要终点为妊娠结局和总生存（OS）。生存分析通过控制已知预后因素的保证时间偏倚进行调整。
在纳入的 1252 名携带种系 突变的患者中（ ，811 例； ，430 例； ，11 例），有 195 名患者在乳腺癌后至少有 1 次妊娠（10 年妊娠率为 19%；95%CI，17%~22%）。16 名（8.2%）和 20 名（10.3%）患者分别发生了人工流产和自然流产。在 150 名分娩的患者中（76.9%；170 名婴儿），有 13 名（11.6%）和 2 名（1.8%）患者发生了妊娠并发症和先天性异常。从乳腺癌诊断到中位随访 8.3 年。在 DFS（调整后的危险比[HR]，0.87；95%CI，0.61 至 1.23； =.41）或 OS（调整后的 HR，0.88；95%CI，0.50 至 1.56； =.66）方面，妊娠组与非妊娠组之间无差异。
携带种系 突变的乳腺癌患者在乳腺癌后妊娠是安全的，不会明显恶化母体预后，且与良好的胎儿结局相关。这些结果为有生育意向的 突变乳腺癌患者提供了保证。
