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Breast-conserving therapy for breast cancer with BRCA mutations: a meta-analysis

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Abstract

Background

BRCA1/2 mutated breast cancer accounts for 3 to 12% of all women with breast cancer and significantly increases the lifetime risk of breast cancer. However, the optimal local treatment for breast cancer with BRCA germline mutation remains controversial. Here we present a meta-analysis to evaluate the impact of breast-conserving therapy (BCT) on the prognosis of breast cancer with BRCA mutation.

Methods

Two independent reviewers searched Pubmed, Embase and Cochrane Central Register of Controlled Trials databases for relevant studies on BCT and BRCA mutated breast cancer. Fixed or random effect models were used for meta-analyses based on whether significant heterogeneity existed among included studies. Funnel plot and Begg’s test were employed for the evaluation of publication bias.

Results

Totally, four studies with five cohorts and a totally 1254 patients were included for meta-analyses. The BCT group involved more T0/T1 (BCT 63.7% Vs. M 48.9%, p < 0.001), N0 (BCT 70.5% Vs. M 56.2%, p < 0.001) and ER negative (BCT 58.8% Vs. M 49.3% p < 0.01) tumors than M group. Patients who received M tended to have prophylactic contralateral mastectomy (BCT 16.5% Vs. M 35.8%, p < 0.001). BCT had a significant higher risk for local recurrence than M (HR 3.838, 95% CI = 2.376–6.201, p < 0.001). The pooled results revealed no significant impact of BCT on disease-free survival (DFS), metastasis-free survival (MFS), breast cancer-specific survival (BCSS) and overall survival (OS).

Conclusions

The present meta-analysis suggested that BCT had increasing local recurrence risk, but did not significantly impact patient survival in terms of DFS, MFS, BCSS and OS. BCT may serve as a safe alternative to mastectomy for breast cancer with BRCA mutation. Further high-quality randomized control trials are warranted to explore the optimal surgical management for BRCA mutation carriers.

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Acknowledgements

This study was funded by Key Projects in the National Science and Technology Pillar Program during the Twelfth Five-year Plan Period (No.2014BAI08B00), Beijing Municipal Science and Technology Project (No. D161100000816005) and State Key Laboratory of Medicinal Chemical Biology (NanKai University) (No. 2019014). The funding agencies had no role in the design or conduct of the study.

Funding

This study was funded by Key Projects in the National Science and Technology Pillar Program during the Twelfth Five‐year Plan Period (No.2014BAI08B00), Beijing Municipal Science and Technology Project (No. D161100000816005) and State Key Laboratory of Medicinal Chemical Biology (NanKai University) (No. 2019014).

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Author notes

  1. Changjun Wang and Yan Lin have contributed equally to this article.

Authors and Affiliations

  1. Department of Breast Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Changjun Wang, Yan Lin, Yidong Zhou, Feng Mao, Xin Huang, Xingtong Zhou, Xi Cao & Qiang Sun

  2. Department of Dermatology, University of California, 90 Medical Center Way, Surge 110, San Francisco, CA, 94143–0989, USA

    Hanjiang Zhu

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  1. Changjun Wang
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Contributions

CW, YZ and QS designed the project; CW, YL and QS performed the literature search and data acquisition; CW and YL performed data extraction; FM, HZ, XH and XZ performed the statistical analyses for heterogeneity investigation; CW, XC, HZ and YZ supported the writing of the paper. All authors read and approved the final manuscript.

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Correspondence to Qiang Sun.

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Wang, C., Lin, Y., Zhu, H. et al. Breast-conserving therapy for breast cancer with BRCA mutations: a meta-analysis. Breast Cancer 29, 314–323 (2022). https://doi.org/10.1007/s12282-021-01312-2

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