单侧、三阴性乳腺癌女性的生存结局与对侧预防性乳房切除术相关。

Survival Outcomes in Women with Unilateral, Triple-Negative, Breast Cancer Correlated with Contralateral Prophylactic Mastectomy.

机构信息

Department of Breast Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA.

Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.

出版信息

Ann Surg Oncol. 2023 Aug;30(8):4648-4656. doi: 10.1245/s10434-022-13056-0. Epub 2023 Jan 21.

DOI:10.1245/s10434-022-13056-0

PMID:36681737

Abstract

BACKGROUND

Despite increased utilization of contralateral prophylactic mastectomy (CPM), there is insufficient evidence that it improves survival in average-risk women with unilateral breast cancer. CPM may be of heightened interest to patients with triple negative breast cancer (TNBC) because these patients are more likely to have BRCA1 mutation-associated disease and are not candidates for the chemoprevention benefits of adjuvant endocrine therapy.

METHODS

Survival and recurrence outcomes were evaluated for all TNBC patients from a multi-institutional database (1999-2018) at two academic cancer programs in two metropolitan cities of the Northeast and Midwest. Median follow-up time was 3.7 years.

RESULTS

Seven hundred and nighty six TNBC patients were evaluated and 15.45% underwent CPM. Women undergoing CPM were more likely to be white (p < 0.001), younger (p < 0.001), and underwent genetic testing (p < 0.001). A borderline survival benefit was observed for TNBC patients undergoing CPM (5-year overall survival 95.1% vs. 85.0%; p = 0.05). There was no difference in survival when BRCA mutation carriers were excluded (5-year overall survival 94.1% vs. 85.2%; p = 0.12). For BRCA mutation carriers, a numeric trend was observed for improved survival for patients undergoing CPM (5-year overall survival 97.2% vs. 84.1%; p = 0.35). Among patients not undergoing CPM, the rate of developing a new primary breast cancer was 2.2% (15/673). Among these 15 patients, 20% (3/15) were known BRCA mutation carriers.

CONCLUSIONS

Our data demonstrate no survival benefit for TNBC patients without BRCA1/2 mutations undergoing CPM.

摘要

背景

尽管对预防性对侧乳房切除术（CPM）的利用率有所增加，但没有足够的证据表明它可以改善单侧乳腺癌的平均风险女性的生存率。CPM 可能对三阴性乳腺癌（TNBC）患者更感兴趣，因为这些患者更有可能患有 BRCA1 突变相关疾病，并且不符合辅助内分泌治疗的化学预防益处。

方法

从两个学术癌症项目的多机构数据库（1999-2018 年）中评估了来自东北部和中西部两个大都市的所有 TNBC 患者的生存和复发结局。中位随访时间为 3.7 年。

结果

共评估了 776 例 TNBC 患者，其中 15.45%接受了 CPM。接受 CPM 的女性更有可能是白人（p<0.001）、年轻（p<0.001）和接受基因检测（p<0.001）。接受 CPM 的 TNBC 患者观察到生存获益的边缘性改善（5 年总生存率为 95.1% vs. 85.0%；p=0.05）。当排除 BRCA 突变携带者时，生存率没有差异（5 年总生存率为 94.1% vs. 85.2%；p=0.12）。对于 BRCA 突变携带者，接受 CPM 的患者的生存呈改善趋势（5 年总生存率为 97.2% vs. 84.1%；p=0.35）。在未接受 CPM 的患者中，新发原发性乳腺癌的发生率为 2.2%（15/673）。在这 15 名患者中，20%（3/15）是已知的 BRCA 突变携带者。