Risk of ipsilateral breast tumor recurrence in primary invasive breast cancer following breast-conserving surgery with BRCA1 and BRCA2 mutation in China
- 174 Downloads
BRCA1/2 germline mutations are associated with a high risk of breast cancer, which may preclude mutation carriers from breast-conserving surgery (BCS). This study retrospectively examined whether mutation status influenced the rate of ipsilateral breast tumor recurrence (IBTR) after BCS in Chinese women.
Patients who underwent BCS were enrolled in carriers group and non-carriers group according to their BRCA1/2 mutation status in the study. The correlations were analyzed between IBTR incidence and BRCA1/2 mutation. The IBTR cases were further separated into new primary tumor (NP) and true local recurrences (TR). The risk factors of NP were studied in multivariate analysis.
1947 consecutive Chinese women with primary invasive breast cancer were selected. 103 patients were identified as BRCA1/2 mutation carriers and 1844 were non-carriers. BRCA1/2 mutation carriers were younger (P < 0.001) with more often negative HER-2 expression (P = 0.01) and tumor size over 2 cm (P = 0.04) than non-carriers. The median follow-up for all patients was 80 months. The rate of IBTR was 3.9% in mutated carriers and 2.0% in non-carriers, respectively (P = 0.16). In IBTR cases, NP incidence was 3.9% in carrier group and 0.6% in non-carrier group, respectively (P < 0.01). After adjustment of all clinical-pathological factors, BRCA1/2 mutation was the only statistical risk factor of NP incidence (HR = 6.29, P = 0.002), while positive lymph node was nearly statistically significant (HR = 2.70, P = 0.06).
BCS may be a rational option for Chinese BRCA1/2 mutation carriers. High NP incidence in mutation carriers should be paid close attention in the future.
KeywordsBreast cancer Breast-conserving surgery BRCA1/2 mutation Ipsilateral breast tumor recurrence
The authors would like to acknowledge the staff in Breast Cancer Center Laboratory who performed BRCA mutation screening and built up the BRCA database. We also appreciate the follow-up group of Peking University Cancer Hospital & Institute who offered us part of survival information of patients.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
A broad informed consent was obtained from all individual participants included in the study. But due to the retrospective nature of the study, specified informed consent was waived.
- 5.Antoniou A, Pharoah PD, Narod S et al (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 72(5):1117–1130. https://doi.org/10.1086/375033 CrossRefGoogle Scholar
- 9.Christiansen P, Carstensen SL, Ejlertsen B et al (2018) Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 57(1):19–25. https://doi.org/10.1080/0284186X.2017.1403042 CrossRefGoogle Scholar
- 11.Hartmann-Johnsen OJ, Kåresen R, Schlichting E et al (2017) Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009. World J Surg Oncol 15(1):118. https://doi.org/10.1186/s12957-017-1184-6 CrossRefGoogle Scholar
- 18.Biglia N, D’Alonzo M, Sgro LG et al (2016) Breast cancer treatment in mutation carriers: surgical treatment. Minerva Ginecol 68(5):548–556Google Scholar
- 19.Giuliano AE, Ballman KV, McCall L et al (2017) Effect of Axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA 318(10):918–926. https://doi.org/10.1001/jama.2017.11470 CrossRefGoogle Scholar
- 21.Smith TE, Lee D, Turner BC et al (2000) True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 48(5):1281–1289CrossRefGoogle Scholar
- 29.Molina-Montes E, Pérez-Nevot B, Pollán M et al (2014) Cumulative risk of second primary contralateral breast cancer in BRCA1/BRCA2 mutation carriers with a first breast cancer: a systematic review and meta-analysis. Breast 23(6):721–742. https://doi.org/10.1016/j.breast.2014.10.005 CrossRefGoogle Scholar
- 31.Easton DF, Ford D, Bishop DT (1995) Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast cancer linkage consortium. Am J Hum Genet 56(1):265–271Google Scholar