Mastectomy or Breast-Conserving Therapy for BRCA1/2 Variant Carriers
Menée en Chine entre 2003 et 2015 auprès de 8 396 patients atteints d'un cancer du sein (âge moyen : 50,8 ans ; 99,8 % de femmes ; durée médiane de suivi : 7,5 ans), cette étude compare l'efficacité, du point de vue de la survie spécifique et de la survie globale, d'une chirurgie conservatrice par rapport à une mastectomie (avec ou sans radiothérapie), en fonction du statut mutationnel de BRCA1/2
Wan et al have retrospectively reviewed 8396 patients with stage I or II breast cancer, 491 with a known BRCA1 (OMIM 113705) or BRCA2 (OMIM 600185) variant, and compared the survival rate among patients undergoing breast-conserving therapy (BCT) with the survival rate among patients undergoing mastectomy, for variant carriers vs noncarriers. From NSABP B-06, EORTC 10801, and other studies, we know that BCT with radiotherapy offers overall survival similar to mastectomy. Recently, studies have shown that BCT with radiotherapy may be associated with improved survival compared with mastectomy. What about survival after BCT among women with a BRCA1/2 germline variant? These women are at increased risk of developing a second primary breast cancer in the same or contralateral breast. Wan et al found that, after 7.5 years of follow-up, BRCA1/2 variant carriers treated with BCT had no better survival than those treated with mastectomy (overall survival: hazard ratio [HR] for BRCA1, 0.61 [95% CI, 0.18-2.12]; P = .44; HR for BRCA2, 0.72 [95% CI, 0.26-1.96]; P = .52) or mastectomy (overall survival: HR for BRCA1, 0.77 [95% CI, 0.27-2.21]; P = .63; HR for BRCA2, 0.62 [95% CI, 0.22-1.73]; P = .37). They concluded that BRCA1/2 variant carriers treated with BCT have a survival comparable to those treated with mastectomy. To our knowledge, this is one of the largest studies to date on this topic.
JAMA Network Open , éditorial en libre accès, 2020