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      Superior survival for breast-conserving therapy over mastectomy in patients with breast cancer: A population-based SEER database analysis across 30 years

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          Abstract

          Introduction

          It has been believed that breast-conserving therapy (lumpectomy plus adjuvant radiation, Lum + RT) and mastectomy without radiation (Mast + NoRT) have equivalent survival outcomes. However, there is a need to re-evaluate the role of lumpectomy plus adjuvant radiation due to changed breast cancer management over time. This study aimed to conduct a population-based study that compare long-term oncologic survival outcomes after Lum + RT vs Mast + NoRT.

          Methods

          The Surveillance, Epidemiology and End Results database was used to identify female breast cancer patients with a primary localized breast cancer diagnosis from 1988 to 2018. The standardized incidence/mortality ratio (SIR/SMR) for breast cancer recurrence (BCR) and breast cancer-specific death (BSD) was estimated by the SEER*Stat program. Cumulative incidences of BCR and BSD were assessed using Gray’s method. We evaluated the effects of Lum + RT vs. Mast + NoRT on breast cancer recurrence-free survival (BRFS) and breast cancer-specific survival (BCSS). Fine-Gray competing risk model analyses, propensity score-adjusted Kaplan-Meier analyses and Cox proportional hazards model analyses were applied.

          Results

          A total of 205,788 women were included in the study. Patients who underwent Lum + RT had higher SIR of BCR (4.14 [95% confidence interval, CI: 3.94-4.34] vs. 1.11 [95% CI: 1.07-1.14]) and lower SMR (9.89 [95% CI: 9.71-10.08] vs. 17.07 [95% CI: 16.82-17.33]) than patients who underwent Mast + NoRT. Lum + RT was associated with higher competing risk of BCR (adjusted hazard ratio [HR]: 1.996, 95% CI: 1.925-2.069, p < 0.001) and lower competing risk of BSD when compared to Mast + RT (adjusted HR: 0.584, 95% CI: 0.572-0.597, p < 0.001). Multivariate Cox regression analysis revealed similar results (adjusted HR after PSW for BRFS: 1.792, 95% CI 1.716-1.871, p < 0.001; adjusted HR after PSW for BCSS: 0.706, 95% CI 0.688-0.725, p < 0.001). These findings persisted in the sensitivity and subgroup analyses.

          Discussion

          The present study further confirmed superior long-term survival with lumpectomy plus adjuvant radiation over mastectomy independent of patient characteristics including age, race, time period, historic subtype, tumor size, historic grade and stage, indicating that this benefit may result from the treatment itself.

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          Most cited references58

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          A Proportional Hazards Model for the Subdistribution of a Competing Risk

          Jason P. Fine, Robert J Gray (1999)
          Article 0 comments Cited 2160 times – based on 0 reviews     Review now
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            Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

            Bernard Fisher, Stewart Anderson, John Bryant … (2002)
            New England Journal of Medicine, 347(16), 1233-1241
            Article 0 comments Cited 1179 times – based on 0 reviews     Review now
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              A Class of $K$-Sample Tests for Comparing the Cumulative Incidence of a Competing Risk

              Robert J Gray (1988)
              Article 0 comments Cited 544 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 04 January 2023
                Publication date Collection: 2022
                Volume: 12
                Electronic Location Identifier: 1032063
                Affiliations
                [1] 1 Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital , Zhengzhou, China
                [2] 2 Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, China
                Author notes

                Edited by: Cynthia Aristei, University of Perugia, Italy

                Reviewed by: Paramita Dasgupta, Cancer Council Queensland, Australia; Angel Montero, HM Madrid Hospital, Spain

                *Correspondence: Jianbo Liu, drliujianbo@ 123456163.com

                This article was submitted to Breast Cancer, a section of the journal Frontiers in Oncology

                Article
                DOI: 10.3389/fonc.2022.1032063
                PMC ID: 9846313
                PubMed ID: 36686746
                SO-VID: 0f03f6ba-7aab-40cc-8a0c-2313f99a25ca
                Copyright © Copyright © 2023 Ke, Wang, Li, Feng, Yan and Liu
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 30 August 2022
                Date accepted : 29 November 2022
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 59, Pages: 11, Words: 4447
                Categories
                Subject: Oncology
                Subject: Original Research

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer,recurrence,cancer-specific survival,competing risk,propensity score weighting,seer
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer, recurrence, cancer-specific survival, competing risk, propensity score weighting, seer

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