Comparison of Survival After Breast-Conserving Therapy vs Mastectomy Among Patients With or Without the BRCA1/2 Variant in a Large Series of Unselected Chinese Patients With Breast Cancer

Abstract

IMPORTANCE Whether patients with breast cancer who carry a BRCA1/2 variant can safely undergo breast-conserving therapy (BCT) remains controversial. OBJECTIVE To compare survival rates after BCT vs mastectomy in BRCA1/2 variant carriers and noncarriers in a large series of unselected patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, a large consecutive series of 8396 unselected patients with primary breast cancer underwent either BCT, mastectomy with radiotherapy, or mastectomy alone from October 1, 2003, to May 31, 2015, at the Breast Center of Peking University Cancer Hospital in China. All patients were assessed for BRCA1/2 germline variant status. Statistical analysis was performed from May 1 to September 30, 2020. MAIN OUTCOMES AND MEASURESThe primary outcomes were breast cancer-specific survival (BCSS) and overall survival (OS); secondary outcomes included recurrence-free survival, distant recurrence-free survival, and ipsilateral breast tumor recurrence. RESULTSOf these 8396 Chinese patients (8378 women [99.8% women]; mean [SD] age, 50.8 [11.4] years; 187 BRCA1 carriers, 304 BRCA2 carriers, and 7905 noncarriers), 3135 (37.3%) received BCT, 1511 (18.0%) received mastectomy with radiotherapy, and 3750 (44.7%) received mastectomy alone. After a median follow-up of 7.5 years (range, 0.3-16.6 years), both BRCA1 and BRCA2 variant carriers treated with BCT had similar rates of survival compared with those treated with mastectomy with radiotherapy (BCSS: hazard ratio [HR] for BRCA1, 0.58 [95% CI, 0.16-2.10]; P = .41; HR for

Breast‐conserving therapy is associated with better survival than mastectomy in Early‐stage breast cancer: A propensity score analysis

“…It is reported that patients with BRCA1 and BRCA2 variant carriers treated with BCT had similar OS compared with those underwent mastectomy. For noncarriers, patients with BCT had better OS than those with mastectomy 22 …”

“…For noncarriers, patients with BCT had better OS than those with mastectomy. 22 The different expression of BRCA1 and BRCA2 maybe one of the explanations. It deserves further investigations in the future.…”

Sociodemographic, Clinical, and Variation Outcomes for Breast Cancer and Breast Cancer-Related Mutations in a Ten-Year Cohort From Neiva, Huila, Colombia

“…Another important finding is the tendency to reclassify according to prognostic staging; this may be related to the immunohistochemical profile of carriers of a genetic mutation [17]. Another interesting trend relates to better survival in patients who underwent breast-conserving therapy (BCT) rather than mastectomy [18]. These findings suggest a variation in outcomes and characteristics in a group with a differential risk.…”

Risk of ipsilateral breast tumor recurrence and contralateral breast cancer in patients with and without TP53 variant in a large series of breast cancer patients

“…Recent retrospective studies have indicated that BCT is even superior to mastectomy in survival in large series of breast cancer [10][11][12][13][14][15][16][17]. We and others also recently suggested that BRCA1/2 pathogenic variant carriers treated with BCT have comparable survival to those treated with mastectomy with or without radiotherapy [18][19][20], but BCT might have 2-fold risk of ipsilateral breast tumor recurrence [18]. Therefore, these findings raise a question of whether BCT is associated with an increased risk of ipsilateral breast tumor recurrence in TP53 variant carriers.…”