Improved overall survival after contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer: A prospective analysis

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• 作者：Bernadette A.M. Heemskerk-Gerritsen ; Matti A. Rookus ; Cora M. Aalfs ; Margreet G.E.M. Ausems ; Johanna M. Collé ; e ; Liesbeth Jansen ; C. Marleen Kets ; Kristien B.M.I. Keymeulen ; Linetta B. Koppert ; Hanne E.J. Meijers-Heijboer ; Thea M. Mooij ; Rob A.E.M. Tollenaar ; Hans F.A. Vasen ; HEBON ; Maartje J. Hooning and Caroline Seynaeve
• 关键词：BRCA1/2 ; breast cancer ; prevention ; contralateral risk-reducing mastectomy ; survival
• 刊名：International Journal of Cancer
• 出版年：2015
• 出版时间：1 February 2015
• 年：2015
• 卷：136
• 期：3
• 页码：668-677
• 全文大小：349K
• ISSN：1097-0215

文摘

Data on survival of BRCA1/2-associated primary breast cancer (PBC) patients who opt for subsequent contralateral risk-reducing mastectomy (CRRM) are scarce and inconsistent. We examined the efficacy of CRRM on overall survival in mutation carriers with a history of PBC. From a Dutch multicentre cohort, we selected 583 BRCA-associated PBC patients, being diagnosed between 1980 and 2011. Over time, 242 patients (42%) underwent CRRM and 341 patients (58%) remained under surveillance. Survival analyses were performed using Cox models, with CRRM as a time-dependent covariate. The median follow-up after PBC diagnosis was 11.4 years. In the CRRM group, four patients developed contralateral breast cancer (2%), against 64 patients (19%) in the surveillance group (p < 0.001). The mortality was lower in the CRRM group than in the surveillance group (9.6 and 21.6 per 1000 person-years of observation, respectively; adjusted hazard ratio 0.49, 95% confidence interval 0.29–0.82). Survival benefit was especially seen in young PBC patients (<40 years), in patients having a PBC with differentiation grade 1/2 and/or no triple-negative phenotype, and in patients not treated with adjuvant chemotherapy. We conclude that CRRM is associated with improved overall survival in BRCA1/2 mutation carriers with a history of PBC. Further research is warranted to develop a model based on age at diagnosis and tumour and treatment characteristics that can predict survival benefit for specific subgroups of patients, aiming at further personalized counselling and improved decision making.