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Does breast-conserving surgery with radiotherapy in BRCA-mutation carriers significantly increase ipsilateral breast tumor recurrence? A systematic review and meta-analysis

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Abstract

Background

Breast-conserving surgery (BCS) is often preferred for localized, small breast cancers, but its safety and efficacy in BRCA-mutation carriers is still controversial. This meta-analysis aimed to determine whether there was any significant difference in the incidence of ipsilateral breast tumor recurrence (IBTR) between BRCA-mutation carriers who underwent BCS and controls with sporadic breast cancer.

Methods

A PubMed search was conducted through March 2020 to identify studies examining the risk of IBTR after BCS in BRCA-mutation carriers versus controls. The Cochrane risk-of-bias tool was used to assess the risk of bias. The pooled risk ratio (RR) was calculated using the random-effects model.

Results

Thirteen studies involving 701 BRCA-mutation carriers and 4788 controls in total were eventually analyzed. In the meta-analysis, IBTR after BCS was significantly higher in BRCA-mutation carriers (RR: 1.589; 95% confidence interval (CI) 1.247–2.024; P < 0.001). Subgroup analysis of the follow-up time found that the RR for IBTR increased as the observation period lengthened (median follow-up: ≧ 7 years [RR: 1.505; 95% CI 1.184–1.913] and ≧ 10 years [RR: 1.601; 95% CI 1.201–2.132], respectively). However, a qualitative meta-analysis of overall survival in three cohort studies found no evidence to suggest a deterioration in overall survival in patients with BCS.

Conclusions

The present study demonstrated that BRCA-mutation carriers with BCS have a higher risk of IBTR, which tended to persist for a long period and become more apparent with longer observation.

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Acknowledgements

This study received no specific grant from any funding agency.

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-0021, Japan

    Miyako Nara, Sakiko Ishihara & Tomoyuki Aruga

  2. Department of Breast Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Sakiko Ishihara

  3. Department of Medical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Atsuko Kitano

  4. Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan

    Nobuko Tamura

  5. Department of General Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan

    Daiki Kobayashi

  6. Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan

    Seigo Nakamura

  7. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Hideko Yamauchi

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  1. Miyako Nara
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Correspondence to Tomoyuki Aruga.

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Nara, M., Ishihara, S., Kitano, A. et al. Does breast-conserving surgery with radiotherapy in BRCA-mutation carriers significantly increase ipsilateral breast tumor recurrence? A systematic review and meta-analysis. Breast Cancer 29, 394–401 (2022). https://doi.org/10.1007/s12282-022-01343-3

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  • DOI: https://doi.org/10.1007/s12282-022-01343-3

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