Abstract
PurposePrevious studies provide inconsistent interpretations of the effect of inherited genetic factors on the survival and prognosis of patients with breast cancer. The aim of this study was to examine the effect of germline BRCA1 and BRCA2 mutation on survival and subsequent breast events in Chinese women who underwent breast‐conserving surgery.MethodsA retrospective review of the clinical and pathological records was performed in patients diagnosed with primary invasive breast cancer between 2005 and 2018 in the cancer registry database. Clinicopathological data and data regarding treatment and outcomes, including date and site of disease progression, were collected. The survival outcomes and independent risk factors were conducted using SPSS.ResultsOverall, a total of 501 patients who underwent breast‐conserving surgery were identified and subjected to analyses, of which 63 cases with BRCA1 or BRCA2 mutation. The median age at diagnosis was 41 (range, 24‐74) for carriers and 37 (range, 17‐84) for noncarriers. After a median follow‐up time of 61 months (range, 8‐161) and 70 months (range, 0‐153), respectively, in carriers and noncarriers, the overall survival (P = .173) and disease‐free survival (P = .424) were not significantly different. Analogously, there was no significant difference between the two groups about the outcomes of ipsilateral breast tumor recurrence (P = .348), yet the contralateral breast cancer (CBC) was overt worse than noncarriers (P < .001). When adjusted to confounding factors, BRCA mutation was the only independent risk factors to CBC (HR = 7.89, P = .01).ConclusionIn this study, BRCA mutation carriers have higher risk of CBC. And, BRCA mutation is the only independent risk factor to CBC. Therefore, intensive surveillance and follow‐up as well as more effective individual prevention are urgent. Decisions on alternatively effective prevention, especially the prevention of CBC, are urgent and should take into account patient prognosis and preferences.
Highlights
Breast cancer is the most common noncutaneous malignancy of women worldwide.[1]
We identified 501 patients who underwent breast-conserving surgery, with 63 BRCA1/2 mutation carriers and 438 noncarriers with invasive breast cancer in this study
This retrospective study indicated no significant difference in Overall survival (OS) between patients carrying a BRCA1 or BRCA2 mutation and sporadic breast cancers
Summary
Breast cancer is the most common noncutaneous malignancy of women worldwide.[1]. It is estimated that breast cancer in China alone accounts for 12.2% of global cases and 9.6% of related deaths.[2]. It is suggested that there was no significant difference between BRCA carriers and noncarriers following breast-conserving therapy as to the incidence of ipsilateral breast cancer recurrence. Published studies reported an increased incidence of contralateral breast cancer in mutation carriers, as compared with noncarriers.[22,23,24,25] even with these preventive strategies, it is apparent that breast-conserving therapy for BRCA carriers is not satisfactory, with a persistent high risk of developing contralateral breast cancer. It is worth noting that the conclusion that higher risk of subsequent breast events after breast-conserving surgery in BRCA carriers is often derived from retrospective studies that have some intrinsic limitations. We conducted this single-institutional retrospective study using propensity score matching method, with an effort to provide an almost accurate information of the outcomes and subsequent breast events after breast-conserving surgery in BRCA carriers in Chinese women. To give more evidence-based medicine concerning the practice of breast-conserving surgery in BRCA carriers
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