The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.
Department of Breast Surgery, St. James's University Hospital, Leeds, LS9 7TF, UK.
Br J Cancer. 2021 May;124(11):1785-1794. doi: 10.1038/s41416-020-01234-4. Epub 2021 Mar 25.
The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions.
This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated 'standard' or 'COVID-altered', in the preoperative, operative and post-operative setting.
Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had 'COVID-altered' management. 'Bridging' endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2-9%) using 'NHS Predict'. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.
The majority of 'COVID-altered' management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
B-MaP-C 研究旨在确定英国 COVID-19 大流行高峰期乳腺癌（BC）管理的变化，以及这些治疗决策的潜在影响。
这是一项全国性的队列研究，研究了在大流行期间接受多学科团队（MDT）指导的早期 BC 患者，在术前、术中和术后指定为“标准”或“COVID 改变”的治疗建议。
在该研究的 3776 名患者（来自 64 个英国单位）中，有 2246 名（59%）接受了“COVID 改变”的治疗管理。在手术能力降低的情况下，使用了“桥接”内分泌治疗（n=951）。在研究期间，有越来越多的机会使用 COVID-19 低风险手术室（59%）。根据国家指南，避免了立即进行乳房重建（n=299）。如果省略辅助化疗（n=81），使用“NHS Predict”中位数获益仅为 3%（IQR 2-9%）。迅速采用了新的循证性部分乳房放疗（n=781，来自 46 个单位）。在治疗过程中，只有 14 名患者（1%）检测出 SARS-CoV-2 呈阳性。
大多数“COVID 改变”的管理决策在很大程度上符合 COVID 前的循证指南，这意味着 COVID-19 大流行不太可能对乳腺癌的生存结果产生负面影响。然而，在这项研究中，BC 表现或诊断延迟的潜在影响尚不清楚。
