METHODS: The study comprised a cohort of women with invasive
breast cancer either receiving BCT or
mastectomy following the criteria for the germline BRCA1/2 mutation test. Germline
DNA for BRCA1/2 testing was derived from blood samples. Survival analyses were performed. The correlations were analyzed between survival and distinct types of surgery. To compare the survival between different surgical management, Kaplan-Meier univariate analysis and multivariate Cox regression was used.
RESULTS: In BRCA1/2 mutation carriers (N=176) and noncarriers (N=293), 25% and 27.3% of the patients received BCT, respectively (P=0.675). Patients receiving
mastectomy (without
radiotherapy or followed by
radiotherapy) have larger
tumor size (P<0.05 both in BRCA1/2 mutation carriers and noncarriers), prognostically worse
tumor characteristics including significantly more advanced TNM stage (P=0.017 and P<0.0001 respectively) and more positive lymph nodes (P=0.008 and P<0.0001, respectively) both in BRCA1/2 mutation carriers and noncarriers. Still, more often received systemic
therapy has also been observed. After adjustment for clinical-pathological characteristics and systemic treatment, patients who received BCT had a similar
breast cancer disease-free survival compared with patients who received
mastectomy, both in BRCA1/2 mutation carriers and noncarriers [HR BRCA1/2 =1.17, confidence interval (CI): 0.57-2.39, P=0.68; HRnoncarriers =0.91, CI: 0.47-1.77, P=0.79, respectively). The recurrence free survival after BCT did not differ from
mastectomy in BRCA1/2 mutation carriers [BCT, 5-year cumulative recurrence-free survival (RFS) =0.95, CI: 0.89-1.00;
mastectomy, 5-year cumulative RFS =0.93, CI: 0.85-1.00], even better for BCT in noncarriers (BCT, 5-year cumulative RFS =0.67, CI: 0.42-0.89;
mastectomy, 5-year cumulative RFS =0.83, CI: 0.71-0.95).
CONCLUSIONS: Thus, BCT may be a safe and rational choice for Chinese female
breast cancer patients with a BRCA1/2 mutation. However,
tumor size, the TNM stage, the number of positive lymph nodes, might be taken into consideration when choosing surgical management.