Zheng Yiqiong, Li Jie, Hong Chenyan, Wu Huan, Lige Wuri, Qi Aiying, Guo Jin, Wang Jiandong, Zhu Li, Li Xiru, Zhang Yanjun
Department of General Surgery, First Medical Center of the People's Liberation Army (PLA) General Hospital, Beijing, China.
School of Medicine, Naikai University, Tianjin, China.
Ann Transl Med. 2020 Dec;8(24):1665. doi: 10.21037/atm-20-7780.
The past two decades have witnessed the increasing application of contralateral prophylactic mastectomy (CPM) for women with breast cancer in the western countries. Over 30% of young patients choose to underwent CPM up to 2015. However, the adoption rate of CPM has not shown a remarkably increasing in Asian countries. In China, only a few centers have introduced CPM, and no relevant literature has been published. In this study, we look forward to identify the clinical features and prognostic factors of women who underwent CPM in our hospital, to inform decision-making processes for both doctors and patients.
The clinical data of 58 eligible patients were retrospectively analyzed. Intergroup comparisons were based on independent samples -test and chi square test. The 5-year disease-free survival (DFS) and overall survival (OS) were obtained by using life tables, and factors affecting the survivals were analyzed by using the Kaplan-Meier method.
The mean age of these women was 40.14±11.17 years, with 30 patients (51.7%) being ≤40 years; 13 patients (22.4%) had a family history of breast cancer; and 49 (69.0%) had known risk factors for breast cancer. The median follow-up period was 66.77 months, the 5-year OS was 89% and the 5-year DFS was 74%. The average age of onset was 41.53 (±10.964) in the disease-free survival group and 34.18 (±10.4) years in the recurrence/metastasis group, and -test revealed a significant difference in the average age between these two groups (P=0.049). Chi-square test showed that the disease progression rate significantly differed among the different age subgroups and among subjects with different body mass index (BMI) (all P≤0.05). Moreover, surgical procedure, family history of breast cancer, and some other factors showed no significant correlation with disease progression (all P>0.05). Kaplan-Meier survival analysis and log rank test further confirmed the above findings.
The majority of patients who choose CPM are young and with known risk factors for breast cancer. Part of the young patients (≤40 years of age) are at a higher risk of disease progression.
在过去二十年中，西方国家乳腺癌女性对侧预防性乳房切除术（CPM）的应用日益增加。截至2015年，超过30%的年轻患者选择接受CPM。然而，CPM在亚洲国家的采用率并未显著增加。在中国，只有少数中心引入了CPM，且尚无相关文献发表。在本研究中，我们期望确定在我院接受CPM的女性的临床特征和预后因素，为医生和患者的决策过程提供参考。
回顾性分析58例符合条件患者的临床资料。组间比较采用独立样本t检验和卡方检验。采用寿命表法计算5年无病生存率（DFS）和总生存率（OS），并采用Kaplan-Meier法分析影响生存率的因素。
这些女性的平均年龄为40.14±11.17岁，其中30例（51.7%）年龄≤40岁；13例（22.4%）有乳腺癌家族史；49例（69.0%）有已知的乳腺癌危险因素。中位随访期为66.77个月，5年OS为89%，5年DFS为74%。无病生存组的平均发病年龄为41.53（±10.964）岁，复发/转移组为34.18（±10.4）岁，t检验显示两组平均年龄有显著差异（P=0.049）。卡方检验表明，不同年龄亚组和不同体重指数（BMI）的受试者疾病进展率有显著差异（均P≤0.05）。此外，手术方式、乳腺癌家族史和其他一些因素与疾病进展无显著相关性（均P>0.05）。Kaplan-Meier生存分析和对数秩检验进一步证实了上述结果。
选择CPM的大多数患者为年轻女性且有已知的乳腺癌危险因素。部分年轻患者（≤40岁）疾病进展风险较高。
