Does breast-conserving surgery with radiotherapy in BRCA-mutation carriers significantly increase ipsilateral breast tumor recurrence? A systematic review and meta-analysis

Abstract

Background: Breast-conserving surgery (BCS) is often preferred for localized, small breast cancers, but its safety and efficacy in BRCA-mutation carriers is still controversial. This meta-analysis aimed to determine whether there was any significant difference in the incidence of ipsilateral breast tumor recurrence (IBTR) between BRCA-mutation carriers who underwent BCS and controls with sporadic breast cancer.

Methods: A PubMed search was conducted through March 2020 to identify studies examining the risk of IBTR after BCS in BRCA-mutation carriers versus controls. The Cochrane risk-of-bias tool was used to assess the risk of bias. The pooled risk ratio (RR) was calculated using the random-effects model.

Results: Thirteen studies involving 701 BRCA-mutation carriers and 4788 controls in total were eventually analyzed. In the meta-analysis, IBTR after BCS was significantly higher in BRCA-mutation carriers (RR: 1.589; 95% confidence interval (CI) 1.247-2.024; P < 0.001). Subgroup analysis of the follow-up time found that the RR for IBTR increased as the observation period lengthened (median follow-up: ≧ 7 years [RR: 1.505; 95% CI 1.184-1.913] and ≧ 10 years [RR: 1.601; 95% CI 1.201-2.132], respectively). However, a qualitative meta-analysis of overall survival in three cohort studies found no evidence to suggest a deterioration in overall survival in patients with BCS.

Conclusions: The present study demonstrated that BRCA-mutation carriers with BCS have a higher risk of IBTR, which tended to persist for a long period and become more apparent with longer observation.

Keywords: BRCA-mutation carriers; Breast-conserving surgery; Hereditary breast and ovarian cancer syndrome; Ipsilateral breast tumor recurrence; Meta-analysis.