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      Is breast conservation superior to mastectomy in early stage triple negative breast cancer?

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          Abstract

          Purpose

          Compare overall survival (OS) and breast cancer-specific survival (BCSS) outcomes of breast conservative therapy (BCT) and mastectomy in a large cohort of patients with early-stage triple negative breast cancer (TNBC), using a propensity score-based matching approach.

          Methods

          Surveillance, Epidemiology, and End Results (SEER) database was used to study the role of RT in early stage TNBC. Primary end points were OS and BCSS. Cox proportional hazard regression models and Kaplan-Meier plots were used to generate the desired outcomes. Propensity score matching was done to minimize bias.

          Results

          12,761 patients with T1-2N0M0 TNBC as their first malignancy were retrieved. Of these 7237 had lumpectomy with RT, and 5524 had mastectomy only. Age, race, marital status, tumor laterality, grade and stage, and receipt of chemotherapy were prognostic variables for OS and BCSS. Among 4848 matched subjects, the 5-year OS was significantly higher in patients with lumpectomy and RT (89%) compared to mastectomy alone (84.5%) (p-value <0.001). Similarly, BCSS was significantly higher in patients with lumpectomy and RT (93%) compared to mastectomy alone (91%) (p-value <0.001). On subgroup analysis, patients who are younger than 40 had similar survival outcomes after either mastectomy alone or lumpectomy with RT. However, those who are older than 60, have any grade or T stage had better survival outcomes with lumpectomy and RT.

          Conclusions

          Overall, lumpectomy followed by RT is associated with better OS and BCSS compared to mastectomy in T1-2N0M0 TNBC patients. Further research is needed to determine the optimal treatment strategy for specific patient subgroups.

          Highlights

          • •

            BCT is associated with better OS compared to mastectomy in early-stage TNBC.

          • •

            BCT is associated with better BCSS compared to mastectomy in early-stage TNBC.

          • •

            Age, race, marital status, and grade/stage are prognostic for early-stage TNBC.

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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
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            Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials

            Michael Gnant (2012)
            Summary Background After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk. Methods We undertook a meta-analysis of individual patient data for 10 801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease. Findings Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35·0% to 19·3% (absolute reduction 15·7%, 95% CI 13·7–17·7, 2p<0·00001) and reduced the 15-year risk of breast cancer death from 25·2% to 21·4% (absolute reduction 3·8%, 1·6–6·0, 2p=0·00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31·0% to 15·6% (absolute recurrence reduction 15·4%, 13·2–17·6, 2p<0·00001) and from 20·5% to 17·2% (absolute mortality reduction 3·3%, 0·8–5·8, 2p=0·005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (≥20%), intermediate (10–19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7·8% (95% CI 3·1–12·5), 1·1% (–2·0 to 4·2), and 0·1% (–7·5 to 7·7) respectively (trend in absolute mortality reduction 2p=0·03). In the few women with pN+ disease (n=1050), radiotherapy reduced the 10-year recurrence risk from 63·7% to 42·5% (absolute reduction 21·2%, 95% CI 14·5–27·9, 2p<0·00001) and the 15-year risk of breast cancer death from 51·3% to 42·8% (absolute reduction 8·5%, 1·8–15·2, 2p=0·01). Overall, about one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10, and the mortality reduction did not differ significantly from this overall relationship in any of the three prediction categories for pN0 disease or for pN+ disease. Interpretation After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. These proportional benefits vary little between different groups of women. By contrast, the absolute benefits from radiotherapy vary substantially according to the characteristics of the patient and they can be predicted at the time when treatment decisions need to be made. Funding Cancer Research UK, British Heart Foundation, and UK Medical Research Council.
            Article 0 comments Cited 547 times – based on 0 reviews     Review now
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              Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.

              Umberto Veronesi, Natale Cascinelli, Luigi Mariani … (2002)
              We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery. From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in the rates of contralateral-breast carcinomas, distant metastases, or second primary cancers. After a median follow-up of 20 years, the rate of death from all causes was 41.7 percent in the group that underwent breast-conserving surgery and 41.2 percent in the radical-mastectomy group (P=1.0). The respective rates of death from breast cancer were 26.1 percent and 24.3 percent (P=0.8). The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy. Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers. Copyright 2002 Massachusetts Medical Society
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                Author and article information

                Contributors
                Omran Saifi
                Zhuo Li
                Youssef H. Zeidan
                Journal
                Journal ID (nlm-ta): Breast
                Journal ID (iso-abbrev): Breast
                Title: The Breast : Official Journal of the European Society of Mastology
                Publisher: Elsevier
                ISSN (Print): 0960-9776
                ISSN (Electronic): 1532-3080
                Publication date PMC-release: 09 February 2022
                Publication date Collection: April 2022
                Publication date (Electronic): 09 February 2022
                Volume: 62
                Pages: 144-151
                Affiliations
                [a ]Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
                [b ]Department of Biostatistics, Mayo Clinic, Jacksonville, FL, USA
                [c ]Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA
                [d ]Faculty of Medicine, American University of Beirut, Beirut, Lebanon
                [e ]Department of Radiation Oncology, Baptist Health, Miami, FL, USA
                [f ]Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, FL, USA
                Author notes
                [∗ ]Corresponding author. Department of Radiation Oncology Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, FL, USA Youssef.Zeidan@ 123456baptisthealth.net
                Article
                Publisher Item ID: S0960-9776(22)00033-9
                DOI: 10.1016/j.breast.2022.02.006
                PMC ID: 8859006
                PubMed ID: 35182994
                SO-VID: b65ff5f9-9104-468e-9785-148929a70826
                Copyright © © 2022 Published by Elsevier Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 1 November 2021
                Date revision received : 7 February 2022
                Date accepted : 8 February 2022
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: radiotherapy,triple negative,breast cancer,propensity matching
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: radiotherapy, triple negative, breast cancer, propensity matching

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