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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2023

28-12-2022 | Mastectomy | Breast Oncology

Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Authors: Sungchan Gwark, MD, PhD, Hwa Jung Kim, MD, PhD, Jisun Kim, MD, PhD, Il Yong Chung, MD, PhD, Hee Jeong Kim, MD, PhD, Beom Seok Ko, MD, PhD, Jong Won Lee, MD, PhD, Byung Ho Son, MD, PhD, Sei Hyun Ahn, MD, PhD, Sae Byul Lee, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2023

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Abstract

Background

Breast-conserving surgery (BCS) plus radiotherapy (BCS + RT) has been shown to improve survival compared with mastectomy in patients with early breast cancer; however, whether this superiority is maintained in breast cancer patients receiving neoadjuvant chemotherapy (NCT) is unclear. We evaluated and compared the survival outcomes after BCS + RT and mastectomy in Korean women with breast cancer treated with NCT.

Methods

We evaluated 1641 patients who received NCT before surgery (BCS or mastectomy). We performed propensity score matching to minimize potential bias due to factors other than the surgical method and compared the 5-year, disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates before and after exact matching.

Results

Among the 1641 patients, 839 (51.1%) underwent BCS + RT and 802 (48.9%) underwent mastectomy. Patients who underwent mastectomy had larger tumors and more frequently had positive nodes. For BCS+RT and mastectomy, the unadjusted 5-year DFS, 5-year DMFS, and 5-year OS rates were 87.0% and 73.1%, 89.5% and 77.0%, and 91.8% and 81.0%, respectively (all p < 0.05 = 0.000). After PSM, 5-year DFS, 5-year DMFS, and 5-year OS rates for BCS + RT and mastectomy were 87.6% and 69.1%, 89.7% and 76.0%, and 89.1% and 75.7%, respectively (all p < 0.05). In both unadjusted and adjusted analyses accounting for various confounding factors, BCS + RT was significantly associated with improved DFS (p < 0.05), DMFS (p < 0.05), and OS (p < 0.05) rates compared with mastectomy.

Conclusions

BCS + RT does not impair DFS and OS in patients treated with NCT. Tumor biology and treatment response are significant prognostic indicators. Our results suggest that BCS + RT may be preferred in most breast cancer patients when both BCS and mastectomy are suitable.
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Metadata
Title
Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy
Authors
Sungchan Gwark, MD, PhD
Hwa Jung Kim, MD, PhD
Jisun Kim, MD, PhD
Il Yong Chung, MD, PhD
Hee Jeong Kim, MD, PhD
Beom Seok Ko, MD, PhD
Jong Won Lee, MD, PhD
Byung Ho Son, MD, PhD
Sei Hyun Ahn, MD, PhD
Sae Byul Lee, MD, PhD
Publication date
28-12-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12993-0

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