The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland.
School of Medicine, National University of Ireland, Galway, Ireland.
Breast. 2021 Apr;56:26-34. doi: 10.1016/j.breast.2021.02.001. Epub 2021 Feb 4.
The non-inferiority of combined breast conservation surgery (BCS) and radiotherapy (breast conservation therapy or BCT) compared to mastectomy in sporadic breast cancer cases is well recognised. Uncertainty remains regarding optimal surgical practice in BRCA mutation carriers.
To evaluate the oncological safety of combined BCT versus mastectomy in BRCA mutation carriers following breast cancer diagnosis.
A systematic review was performed as per PRISMA and MOOSE guidelines. Observational studies comparing BCS and mastectomy in BRCA carriers were identified. Dichotomous variables were pooled as odds ratios (OR) using the Mantel-Haenszel method. Log hazard ratios (lnHR) for locoregional recurrence (LRR), contralateral breast cancer, disease-free and overall survival and their standard errors were calculated from Kaplan-Meier or cox-regression analyses and pooled using the inverse variance method.
Twenty three studies of 3807 patients met inclusion criteria; 2200 (57.7%) were BRCA1 and 1212 (31.8%) were BRCA2 carriers. Median age at diagnosis was 41 years with 96 months follow up. BCS was performed on 2157 (56.7%) while 1408 (41.5%) underwent mastectomy. An increased risk of LRR was observed in patients treated with BCS (HR:4.54, 95% Confidence Interval: 2.77-7.42, P < 0.001, heterogeneity (I) = 0%). However, the risks of contralateral breast cancer (HR:1.51, 95%CI: 0.44-5.11, P = 0.510, I = 80%), disease recurrence (HR:1.16, 95%CI: 0.78-1.72, P = 0.470, I = 44%), disease-specific recurrence (HR:1.58, 95%CI: 0.79-3.15, P = 0.200, I = 38%) and death (HR:1.10, 95%CI: 0.72-1.69, P = 0.660, I = 38%) were equivalent for combined BCT and mastectomy.
Survival outcomes following combined BCT is comparable to mastectomy in BRCA carriers. However, the risk of LRR is increased. Patient counselling should be tailored to incorporate these findings.
保乳手术（BCS）联合放疗（保乳治疗或 BCT）与乳腺癌患者的乳房切除术相比具有非劣效性，这已得到广泛认可。然而，BRCA 突变携带者的最佳手术实践仍存在不确定性。
评估 BRCA 突变携带者乳腺癌诊断后联合 BCT 与乳房切除术的肿瘤安全性。
按照 PRISMA 和 MOOSE 指南进行系统评价。确定了比较 BRCA 携带者中 BCS 和乳房切除术的观察性研究。使用 Mantel-Haenszel 方法将二项变量汇总为优势比（OR）。局部区域复发（LRR）、对侧乳腺癌、无病和总生存率的对数危险比（lnHR）及其标准误差来自 Kaplan-Meier 或 cox 回归分析，并使用逆方差法进行汇总。
纳入了 3807 例患者的 23 项研究；2200 例（57.7%）为 BRCA1 携带者，1212 例（31.8%）为 BRCA2 携带者。诊断时的中位年龄为 41 岁，随访时间为 96 个月。2157 例患者接受了 BCS（56.7%），1408 例患者接受了乳房切除术（41.5%）。接受 BCS 治疗的患者 LRR 风险增加（HR：4.54，95%置信区间：2.77-7.42，P<0.001，异质性（I）=0%）。然而，对侧乳腺癌（HR：1.51，95%CI：0.44-5.11，P=0.510，I=80%）、疾病复发（HR：1.16，95%CI：0.78-1.72，P=0.470，I=44%）、疾病特异性复发（HR：1.58，95%CI：0.79-3.15，P=0.200，I=38%）和死亡（HR：1.10，95%CI：0.72-1.69，P=0.660，I=38%）的风险在联合 BCT 和乳房切除术之间是等效的。
BRCA 携带者联合 BCT 的生存结果与乳房切除术相当。然而，LRR 的风险增加。患者咨询应根据这些发现进行调整。
