Breast-Conserving Tx, Mastectomy Have Similar Outcomes
In a multicenter cohort study of 575 South Korean patients with BRCA1 or BRCA2 pathogenic variants, breast-conserving treatment demonstrated comparable oncologic outcomes to mastectomy over a median follow-up of 8.3 years. After propensity score matching, no significant differences between the two surgical approaches were found in terms of locoregional recurrence, distant recurrence, and overall survival.
METHODOLOGY:
Breast-conserving treatment has been established as a viable alternative to mastectomy for patients with sporadic breast cancer, showing comparable prognoses.
Current guidelines specify that patients with breast cancer with genetic predispositions, such as BRCA1 or BRCA2 pathogenic variants, may consider prophylactic bilateral mastectomy for risk reduction, though the suitability and safety of breast-conserving treatment in these patients remain relatively uncertain.
or pathogenic variants, may consider prophylactic bilateral mastectomy for risk reduction, though the suitability and safety of breast-conserving treatment in these patients remain relatively uncertain. Researchers conducted a retrospective multicenter cohort study analyzing 575 female patients with BRCA1 or BRCA2 pathogenic variants who underwent either breast-conserving treatment (377 patients) or mastectomy (198 patients) at 13 institutions in South Korea from January 2008 through December 2015.
or pathogenic variants who underwent either breast-conserving treatment (377 patients) or mastectomy (198 patients) at 13 institutions in South Korea from January 2008 through December 2015. Analysis included propensity score matching with a 1:1 greedy nearest neighbor method to adjust for age, tumor size, lymph node metastasis, histologic grade, and tumor subtype, resulting in 159 matched pairs of patients.
Primary outcome measures encompassed locoregional recurrence–free survival, distant recurrence–free survival, and overall survival, with a median follow-up period of 8.3 years (interquartile range, 6.4-9.6 years).
TAKEAWAY:
Multivariate analysis revealed that breast-conserving treatment was not significantly associated with oncologic outcomes compared with mastectomy (hazard ratio [HR], 0.96 [95% CI, 0.36-2.59] for locoregional recurrence–free survival; 0.62 [95% CI, 0.28-1.38] for distant recurrence–free survival; and 0.82 [95% CI, 0.34-1.98] for overall survival).
Tumor size emerged as the sole factor significantly associated with distant recurrence–free survival (HR, 3.87; 95% CI, 1.51-9.94; P < .01), whereas lymph node metastasis significantly affected overall survival (HR, 3.78; 95% CI, 1.44-9.97; P < .01).
< .01), whereas lymph node metastasis significantly affected overall survival (HR, 3.78; 95% CI, 1.44-9.97; < .01). In subgroup analysis among matched patients based on BRCA1 or BRCA2 status, tumor size, lymph node metastasis, histologic grade, and subtype, breast-conserving treatment showed no significant association with risk for recurrence.
IN PRACTICE:
'The findings from this cohort study of patients with BRCA1 or BRCA2 pathogenic variants suggested that there were no significant differences in oncologic outcomes between patients who underwent [breast-conserving treatment] and those who underwent mastectomy. Therefore, breast conservation with close surveillance can be considered a viable treatment option for BRCA1 or BRCA2 pathogenic variant carriers,' wrote the authors of the study.
SOURCE:
The study was led by Janghee Lee, MD, PhD, Ewha Womans University Mokdong Hospital in Seoul, Republic of Korea. It was published online on May 14 in JAMA Network Open .
LIMITATIONS:
The study was retrospective, which introduces potential selection bias. The cohort did not clearly indicate whether BRCA pathogenic variant test results were available before surgery, which could have influenced surgical approach decisions. Additionally, the study was unable to include information on the precise site of BRCA1 or BRCA2 pathogenic variants and other pathogenic variants, such as TP53 , which could impact recurrence and prognosis.
DISCLOSURES:
The study received support from the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group and the Korean Surgical Society. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.
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