Comparing the Prognoses of Breast-Conserving Surgeries for Differently Aged Women with Early Stage Breast Cancer: Use of a Propensity Score Method

Abstract

Background. To explore the effect of age on the prognosis of patients with early stage breast cancer after breast-conserving surgery (BCS) and to provide references for young patients. Methods. All clinical data of patients with early breast cancer undergoing BCS who were treated at Shengjing Hospital of China Medical University from January 2011 to May 2016 were obtained. The primary endpoints were local recurrence (LR) and distant recurrence, and the secondary endpoint was breast cancer-specific survival (BCSS). Chi-squared tests and Fisher’s exact tests were used for statistical analysis. Disease-free survival (DFS) and BCSS were calculated by Kaplan–Meier survival analysis and compared using log-rank tests. Logistic regression was used for multivariable analysis of the effect of age in different subgroups. Propensity score matching (PSM) was used to reduce the bias confounding factors on oncological outcomes. Results. Younger patients had higher Ki-67 expression ( P = 0.048 ) and larger tumors ( P = 0.042 ) compared to older patients. No other clinical features were significantly different between age groups. There was no significant difference between the two groups in BCSS ( P = 0.186 ); however, DFS was significantly different before PSM ( P = 0.012 ). Triple-negative breast cancer and Ki-67 positivity combined with younger age at diagnosis were associated with a higher risk of recurrence ( P = 0.018 and P = 0.046 , respectively). After PSM, there were no significant differences in BCSS nor DFS between the two age groups ( P = 0.559 and P = 0.261 , respectively). Conclusion. BCS for young patients is not associated with increased DFS nor BCSS. However, young patients with triple-negative breast cancer and/or Ki-67 positivity have a poor prognosis. In sum, BCS may be appropriate for a subgroup of young patients.

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

“…Of the other evaluated studies, 10 found no difference in the OS, between BCS and mastectomy [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 ] while one noted an improved disease free survival and OS with BCS [ 48 ]. A local recurrence, however, was noted to be greater in patients undergoing BCS in two studies [ 44 , 49 ].…”