Blundo Concetta, Giroda Massimo, Fusco Nicola, Sajjadi Elham, Venetis Konstantinos, Leonardi M Cristina, Vicini Elisa, Despini Luca, Rossi Claudia F, Runza Letterio, Sfondrini Maria S, Piciotti Roberto, Di Loreto Eugenia, Scarfone Giovanna, Guerini-Rocco Elena, Viale Giuseppe, Veronesi Paolo, Buonomo Barbara, Peccatori Fedro A, Galimberti Viviana E
Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Front Oncol. 2021 Aug 24;11:723693. doi: 10.3389/fonc.2021.723693. eCollection 2021.
Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.
乳腺癌是妊娠期最常见的恶性肿瘤。对于妊娠早期乳腺癌（PrBC），保乳手术（BCS）联合延迟放疗是乳房切除术的合理替代方案，长期以来乳房切除术一直被视为标准治疗方法。遗憾的是，目前尚无针对这些患者手术管理的具体指南。在本研究中，我们调查了妊娠早期PrBC女性患者行BCS的可行性和安全性。本研究纳入了在两个PrBC专科中心联合管理的所有在妊娠早期被诊断为PrBC的患者。所有患者均接受了BCS，产后对同侧乳房进行辅助放疗。首先在术前活检中分析组织病理学特征和生物标志物。主要结局是孤立性局部复发（ILR）。在168例PrBC患者中，67例（39.9%）在妊娠早期被诊断。其中，30例患者（年龄范围23 - 43岁；中位数 = 36岁；孕周2 - 12周；中位数 = 7周；中位随访时间 = 6.5年）符合纳入标准。接受根治性手术的患者（n = 14）作为对照。所有患者均未发生围手术期手术并发症。术后3个月（n = 30）、1年（n = 27）和5年（n = 18）均未观察到ILR。在研究组中，4例（12.3%）患者在6 - 13年后出现ILR或新发癌，4例患者在3 - 7年后发生远处转移。经过14 - 17年的随访，这些患者仍存活且无疾病。对照组的复发和转移率无显著差异。这些发现提供了证据，表明妊娠早期PrBC行BCS对母亲和婴儿而言都是可行且相当安全的。
