Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer
Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer
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DOI：
10.1200/jco.2005.02.7888
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发表时间：
2006-06-01
影响因子：
45.3
通讯作者：
Weber, BL
中科院分区：
文献类型：
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作者：
Pierce, LJ;Levin, AM;Weber, BL
目的比较BRCA 1/2基因突变携带者乳腺癌保乳手术和放疗的疗效，并与445例散发性乳腺癌对照组进行比较。主要终点是乳腺内肿瘤复发率（IBTR）和对侧乳腺癌（CBC）。突变携带者的中位随访时间为7.9年，对照组为6.7年。结果携带者和对照组之间的IBTR总体无显著差异; 10年和15年;估计携带者为12%和24%，对照组为9%和17%，分别为（风险比[HR]，1.37; P = 0.19）。IBTR的多变量分析发现，BRCA 1/2突变状态是一个独立的预测因子，当从分析中删除携带者进行cophorectomy（HR，1.99; P = 0.04）; IBTR的发病率在携带者进行卵巢切除术是没有显着差异，在散发的控制（P = 0.37）。携带者的CBCs显著高于对照组，10年和15年的估计值分别为26%和39%。对照组分别为3%和7%（HR，10.43; P < .0001）。三苯氧胺的使用显着降低突变携带者CBCs的风险（HR，0.31; P = .05）。结论在10年IBTR的风险是相似的BRCA 1/2携带者接受保乳手术谁接受卵巢切除术与散发控制。正如预期的那样，携带者的CBC显著增加。虽然突变携带者的CBCs发生率显着降低，但这一比率仍显着高于对照组。需要接受他莫昔芬的其他策略来减少这些高危妇女的对侧癌症。
Purpose We compared the outcome of breast-conserving surgery and radiotherapy in BRCA1/2 mutation carriers with breast cancer versus that of matched sporadic controls.Methods A total of 160 BRCA 712 mutation carriers with breast cancer were matched with 445 controls with sporadic breast cancer. Primary end points were rates of in-breast tumor recurrence (IBTR) and contralateral breast cancers (CBCs). Median follow-up was 7.9 years for mutation carriers and 6.7 years for controls.Results There was no significant difference in IBTR overall between carriers and controls; 10- and 15-year; estimates were 12% and 24% for carriers and 9% and 17% for controls, respectively (hazard ratio [HR], 1.37; P = .19). Multivariate analyses for IBTR found BRCA1/2 mutation status to be an independent predictor of IBTR when carriers who had undergone cophorectomy were removed from analysis (HR, 1.99; P = .04); the incidence of IBTR in carriers who had undergone oophorectomy was not significantly different from that in sporadic controls (P = .37). CBCs were significantly greater in carriers versus controls, with 10- and 15-year estimates of 26% and 39%. for carriers and 3% and 7% for controls, respectively (HR, 10.43; P < .0001). Tamoxifen use significantly reduced risk of CBCs in mutation carriers (HR, 0.31; P = .05).Conclusion IBTR risk at 10 years is similar in BRCA1/2 carriers treated with breast conservation surgery who undergo oophorectomy versus sporadic controls. As expected, CBCs are significantly increased in carriers. Although the incidence of CBCs was significantly reduced in mutation carriers who this rate remained significantly greater than in controls. Additional strategies received tamoxifen, are needed to reduce contralateral cancers in these high-risk women.