Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis

被引:125
作者
Valachis, Antonis [1 ,2 ]
Nearchou, Andreas D. [1 ]
Lind, Pehr [1 ,3 ]
机构
[1] Malarsjukhuset, Dept Oncol, S-63188 Eskilstuna, Sweden
[2] Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
[3] Karolinska Inst, S-11883 Stockholm, Sweden
关键词
BRCA; Breast cancer; Breast-conserving therapy; Meta-analysis; CONTRALATERAL PROPHYLACTIC MASTECTOMY; QUALITY-OF-LIFE; CONSERVING TREATMENT; RISK REDUCTION; RADIOTHERAPY; SURVIVAL; WOMEN; CHEMOTHERAPY; RECURRENCE; OUTCOMES;
D O I
10.1007/s10549-014-2890-1
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
This meta-analysis investigates the oncological safety of breast-conserving therapy BCT in BRCA-mutation carriers and the risk for contralateral breast cancer (CBC) compared with non-carriers, potential risk factors for ipsilateral breast recurrence (IBR) or CBC and grades these factors based on the level of evidence. A PubMed search was conducted through April 2013 to identify studies that described the risk for IBR and CBC after BCT in BRCA-mutation carriers versus non-carriers as well as studies that investigated risk factors for IBR and CBC in BRCA-mutation carriers. Results were summarized using meta-analysis when sufficient studies were available. Ten studies investigated the oncological safety of BCT in BRCA-mutation carriers versus non-carriers. There was no significant difference in IBR between carriers and controls (RR 1.45, 95 % CI 0.98-2.14). However, a significant higher risk for IBR in BRCA-mutation carriers was observed in studies with a median follow-up a parts per thousand yen7 years (RR 1.51, 95 % CI 1.15-1.98). CBCs were significantly greater in carriers versus controls (RR 3.56, 95 % CI 2.50-5.08). Use of adjuvant chemotherapy and oophorectomy were associated with a significantly lower risk for IBR in BRCA-mutation carriers. Three factors were associated with a lower risk for CBC in BRCA-mutation carriers: oophorectomy, use of tamoxifen, and age at first breast cancer. Based on current evidence, the use of BCT in BRCA-mutation carriers can be considered a reasonable option since it does not seem to increase the risk for IBR. However, several aspects should be taken into account before the final decision-making.
引用
收藏
页码:443 / 455
页数:13
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