Huang Hongbo, Wei Tingting, Zhang Aijie, Zhang Heng, Kong Lingquan, Li Yunhai, Li Fan
Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Health Management Center, University-Town Hospital of Chongqing Medical University, Chongqing, China.
Clin Breast Cancer. 2023 Oct;23(7):752-762.e7. doi: 10.1016/j.clbc.2023.07.010. Epub 2023 Aug 3.
Contralateral prophylactic mastectomy (CPM) has been performed for several decades in patients with unilateral breast cancer (BC). However, the survival benefits of CPM are controversial, particularly in young women.
In this retrospective study, the clinical total of 69,000 young female patients (age ≤ 40 years) who were diagnosed to have unilateral BC and underwent unilateral mastectomy (UM) or CPM between January 1, 2000 and December 31, 2019 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to minimize selection bias and overcome differences in tumor characteristics between the CPM and UM groups. Overall survival (OS) and BC-specific survival (BCSS) were assessed using Kaplan-Meier curves and compared across groups using log-rank test. Multivariable Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs).
A total of 36,528 patients (21,600 and 14,928 patients in the UM and CPM groups, respectively) were included in follow study. The CPM group showed a higher 5-year OS rate (82.1% vs. 75.8%) and a higher 5-year BCSS rate (83.5% vs. 77.7%) than the UM group. Multivariate Cox analysis after PSM (n = 13,089) showed that CPM significantly decreased 25% risk of all-cause mortality (OS, HR: 0.75, 95% confidence interval [CI]: 0.70-0.80; P < .001) and 25% risk of BC-specific mortality (BCSS, HR: 0.75, 95% CI: 0.70-0.80; P < .001) in young BC patients as compared to UM.
This study suggests that CPM improved OS and BCSS benefits in young BC patients as compared to UM. Randomized clinical trials with a larger sample size are required in the future to confirm these results.
对单侧乳腺癌（BC）患者进行对侧预防性乳房切除术（CPM）已有数十年历史。然而，CPM的生存获益存在争议，尤其是在年轻女性中。
在这项回顾性研究中，从监测、流行病学和最终结果（SEER）数据库中检索了2000年1月1日至2019年12月31日期间被诊断为单侧BC并接受单侧乳房切除术（UM）或CPM的69000名年轻女性患者（年龄≤40岁）的临床数据。进行倾向评分匹配（PSM）以尽量减少选择偏倚并克服CPM组和UM组之间肿瘤特征的差异。使用Kaplan-Meier曲线评估总生存期（OS）和BC特异性生存期（BCSS），并使用对数秩检验进行组间比较。进行多变量Cox比例风险回归分析以估计风险比（HR）。
共有36528例患者（UM组和CPM组分别为21600例和14928例）纳入随访研究。CPM组的5年OS率（82.1%对75.8%）和5年BCSS率（83.5%对77.7%）均高于UM组。PSM后（n = 13089）的多变量Cox分析显示，与UM相比，CPM显著降低了年轻BC患者25%的全因死亡率风险（OS，HR：0.75，95%置信区间[CI]：0.70 - 0.80；P <.001）和25%的BC特异性死亡率风险（BCSS，HR：0.75，95%CI：0.70 - 0.80；P <.001）。
本研究表明，与UM相比，CPM改善了年轻BC患者的OS和BCSS获益。未来需要更大样本量的随机临床试验来证实这些结果。
