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Breast Cancer Research and Treatment

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01-10-2020 | Mastectomy | Epidemiology

Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method

Authors: Lize Wang, Yingjian He, Jinfeng Li, Tianfeng Wang, Yuntao Xie, Zhaoqing Fan, Tao Ouyang

Published in: Breast Cancer Research and Treatment | Issue 3/2020

Abstract

Purpose

This study aimed to compare the effect of BCT versus mastectomy on the recurrence and survival of different-aged patients, and to investigate whether effects of BCT versus mastectomy on survival of young patients were consistent with those of old patients.

Methods

Data on women with primary invasive breast cancer between 2007 and 2011 were extracted from the institutional database of Breast Center. Disparities in hormone receptor, tumor size, lymph node status, and Her-2 status between BCT and mastectomy groups were adjusted using the propensity score (PS) adjustment method. Patients were divided by age into two groups (≤ 40 years and > 40 years). We assessed proportions of local recurrence (LR), distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) in different-aged groups; this assessment was further stratified by surgical treatment.

Results

A total of 2964 patients were included; 565 (19%) were aged ≤ 40 years. In the entire cohort, hazard ratios (HR) of BCT versus mastectomy for DDFS and DFS were 0.56 (P = 0.029) and 0.55 (P = 0.008), respectively. After PS adjustment, there was no significant difference between BCT and mastectomy in LR, DDFS, DFS and BCSS in the young age group. In the old age group, women who underwent BCT exhibited improved DDFS (HR 0.57, 95% CI 0.39–0.84, P = 0.004).

Conclusions

BCT did not significantly affect survival outcomes of young patients with breast cancer. Superior survival of BCT compared to mastectomy was observed only in old patients.

Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232. https://doi.org/10.1056/NEJMoa020989CrossRef

Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241. https://doi.org/10.1056/NEJMoa022152CrossRef

Lagendijk M, van Maaren MC, Saadatmand S et al (2018) Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer 142(1):165–175. https://doi.org/10.1002/ijc.31034CrossRefPubMed

Plichta JK, Thomas SM, Vernon R et al (2020) Breast cancer tumor histopathology, stage at presentation, and treatment in the extremes of age. Breast Cancer Res Treat 180(1):227–235. https://doi.org/10.1007/s10549-020-05542-4CrossRefPubMed

Azim HA Jr, Partridge AH (2014) Biology of breast cancer in young women. Breast Cancer Res 16(4):427. https://doi.org/10.1186/s13058-014-0427-5CrossRefPubMedPubMedCentral

Azim HA Jr, Michiels S, Bedard PL et al (2012) Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res 18(5):1341–1351. https://doi.org/10.1158/1078-0432.CCR-11-2599CrossRefPubMed

Kim SW, Chun M, Han S et al (2016) Young age is associated with increased locoregional recurrence in node-positive breast cancer with luminal subtypes. Cancer Res Treat 49(2):484–493. https://doi.org/10.4143/crt.2016.246CrossRefPubMedPubMedCentral

van der Sangen MJ, van de Wiel FM, Poortmans PM et al (2011) Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1,451 patients aged ≤40 years. Breast Cancer Res Treat 127(1):207–215. https://doi.org/10.1007/s10549-010-1110-xCrossRefPubMed

Liu Z, Sahli Z, Wang Y et al (2018) Young age at diagnosis is associated with worse prognosis in the Luminal A breast cancer subtype: a retrospective institutional cohort study. Breast Cancer Res Treat 172(3):689–702. https://doi.org/10.1007/s10549-018-4950-4CrossRefPubMedPubMedCentral

10.

van Maaren MC, de Munck L, de Bock GH et al (2016) 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol 17(8):1158–1170. https://doi.org/10.1016/S1470-2045(16)30067-5CrossRef

11.

Agarwal S, Pappas L, Neumayer L et al (2014) Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 149(3):267–274. https://doi.org/10.1001/jamasurg.2013.3049CrossRefPubMed

12.

Hartmann-Johnsen OJ, Kåresen R, Schlichting E et al (2015) Survival is better after breast conserving therapy than mastectomy for early stage breast cancer: a registry-based follow-up study of Norwegian women primary operated between 1998 and 2008. Ann Surg Oncol 22(12):3836–3845. https://doi.org/10.1245/s10434-015-4441-3CrossRefPubMedPubMedCentral

13.

American Cancer Society (2017) Breast Cancer Facts & Figures 2017–2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-fgures/breast-cancer-facts-and-fgures-2017-2018.pdf. Accessed 23 Apr 2018

14.

Siesling S, van der Aa MA, Coebergh JW et al (2008) Time-space trends in cancer incidence in The Netherlands in 1989–2003. Int J Cancer 122(9):2106–2114. https://doi.org/10.1002/ijc.23358CrossRefPubMed

15.

Wang K, Ren Y, Li H et al (2016) Comparison of clinicopathological features and treatments between young (40 years) female breast cancer patients in west China: a retrospective, epidemiological, multicenter, case only study. PLoS ONE 11(3):e0152312. https://doi.org/10.1371/journal.pone.0152312CrossRefPubMedPubMedCentral

16.

Kim HJ, Han W, Yi OV et al (2011) Young age is associated with ipsilateral breast tumor recurrence after breast conserving surgery and radiation therapy in patients with HER2-positive/ER-negative subtype. Breast Cancer Res Treat 130(2):499–505. https://doi.org/10.1007/s10549-011-1736-3CrossRefPubMed

17.

Park YH, Lee SJ, Jung HA et al (2015) Prevalence and clinical outcomes of young breast cancer (YBC) patients according to intrinsic breast cancer subtypes: Single institutional experience in Korea. Breast 24(3):213–217. https://doi.org/10.1016/j.breast.2015.01.012CrossRefPubMed

18.

Vila J, Gandini S, Gentilini O (2015) Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast 24(3):175–181. https://doi.org/10.1016/j.breast.2015.02.002CrossRefPubMed

19.

Botteri E, Bagnardi V, Rotmensz N et al (2010) Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol 21(4):723–728. https://doi.org/10.1093/annonc/mdp386CrossRefPubMed

20.

Vaidya JS, Wenz F, Bulsara M et al (2014) Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 383:603–613. https://doi.org/10.1016/S0140-6736(13)61950-9CrossRefPubMed

21.

Wang L, Li J, Wang T et al (2019) Impact of clinical and pathological factors on local recurrence after breast-conserving treatment: CT-based localization for a tumor bed boost yielded better local control when compared with a surgical scar. J Cancer 10(3):708–715. https://doi.org/10.7150/jca.28328CrossRefPubMedPubMedCentral

22.

Sinnadurai S, Kwong A, Hartman M et al (2018) Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open 3(1):48–55. https://doi.org/10.1002/bjs5.50111CrossRefPubMedPubMedCentral

23.

Ye JC, Yan W, Christos PJ et al (2015) Equivalent survival with mastectomy or breast-conserving surgery plus radiation in young women aged < 40 years with early-stage breast cancer: a national registry-based stage-by-stage comparison. Clin Breast Cancer 15(5):390–397. https://doi.org/10.1016/j.clbc.2015.03.012CrossRefPubMedPubMedCentral

24.

Pesce CE, Liederbach E, Czechura T et al (2014) Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Data Base. J Am Coll Surg 219(1):19–28. https://doi.org/10.1016/j.jamcollsurg.2014.03.043CrossRefPubMed

25.

Kurian AW, Lichtensztajn DY, Keegan TH et al (2014) Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA 312(9):902–914. https://doi.org/10.1001/jama.2014.10707CrossRefPubMedPubMedCentral

Title: Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method
Authors: Lize Wang
Yingjian He
Jinfeng Li
Tianfeng Wang
Yuntao Xie
Zhaoqing Fan
Tao Ouyang
Publication date: 01-10-2020
Publisher: Springer US
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 3/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05821-0

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