Breast-Conserving Therapy Has Better Prognosis for Tumors in the Central and Nipple Portion of Breast Cancer Compared with Mastectomy: A SEER Data-Based Study

Abstract

Background and ObjectivesCurrently, the location of primary tumor was an independent prognostic factor of breast cancer. Tumors in the central and nipple portion (TCNP) had poor prognosis compared to other peripheral quadrants. The breast-conserving therapy (BCT) is becoming increasingly common worldwide in breast cancer operations. However, whether the availability of BCT was performed for TCNP remained a matter of debate. We sought to investigate whether BCT was suitable for TCNP with respect to survival outcomes, compared with mastectomy therapy.MethodsUtilizing the Surveillance, Epidemiology, and End Results (SEER) database, we obtained TCNP breast cancer patients diagnosed during the period of 2010–2015. One-to-one (1:1) propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of BCT and mastectomy groups. Univariate and multivariate Cox proportional hazard models were applied to estimate the factors associated with breast cancer-specific survival (BCSS) and overall survival (OS). Survival analysis was performed with the Kaplan–Meier method.ResultsIn the overall cohort, a total of 9,900 patients were enrolled. We found that patients with BCT showed significantly better BCSS (log-rank, p < 0.001) and OS (log-rank, p < 0.001) than the mastectomy group before PSM. The same finding was also shown in 5,820 patients after PSM. Additionally, none of the subgroups, including age, sex, race, histological grade, AJCC stage, and molecular subtype undergoing mastectomy therapy, had better BCSS than BCT.ConclusionsOur study was the first research to show that BCT exhibited superior prognosis in the cohort of TCNP from SEER databases than mastectomy therapy. This finding could provide a cue for treatment strategies for suitable TCNP patients, especially those with a strong willingness to conserve their breasts.

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience

“…[31][32][33] Despite this, BCS at the central tumor location not only does not worsen but also significantly improves the oncological results of treatment in comparison with mastectomy, while achieving the same results as BCS in cases with other tumor locations. [34][35][36][37][38] Current clinical practice considers BCS as a safe option for central tumors, which is consistent with our experience. However, reconstruction of the central part of the breast can be technically challenging.…”

Survival Outcomes After Breast-Conserving Therapy Compared With Mastectomy for Patients With Early-Stage Invasive Micropapillary Carcinoma of the Breast: A SEER Population-Based Study

“…Similarly, BCT had a higher overall survival rate than mastectomy for breast cancer in a propensity score matching study based on the SEER database by Wrubel et al. ( 28 ). However, most of these studies included invasive ductal breast cancer (IDC) patients.…”

“…In 2016, Marissa et al (16) controversially reported that BCT improved 10-year OS compared with mastectomy after hierarchical analysis of disease stages and adjustment of confounding variables. Similarly, BCT had a higher overall survival rate than mastectomy for breast cancer in a propensity score matching study based on the SEER database by Wrubel et al (28). However, most of these studies included invasive ductal breast cancer (IDC) patients.…”

Breast conserving therapy for central breast cancer in the United States

“…So in our study, T3–4 patients were included. Wang's study compared the safety of BCT versus mastectomy for CLBC [ 22 ]. But in our study, non-breast conserving patients included not only mastectomy, but also breast reconstruction.…”