Overall survival after mastectomy <i>versus</i> breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis

Rajan, Kiran K; Fairhurst, Katherine; Birkbeck, Beth; Novintan, Shonnelly; Wilson, Rebecca; Savović, Jelena; Holcombe, Chris; Potter, Shelley

doi:10.1093/bjsopen/zrae040

Cited by 4 publications

References 120 publications

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Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

Ku,

Desai,

Singhal

et al. 2024

J Reconstr Microsurg

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Background: Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-days post-operative complications between these two techniques. Methods: We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications. Results: A cohort of 8,403 breast cancer patients was analyzed. 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p<0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p<0.001), exhibited a higher BMI (31.73 vs. 26.93, p<0.001), had a greater prevalence of diabetes mellitus (11.0% vs. 5.0%, p<0.001). They also had a higher ASA classification (2.33 vs. 2.15, p<0.001), shorter operative time (173.39 vs. 216.20 min, p<0.001), and a higher proportion of outpatient procedures (83.7% vs 39.5%, p<0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients, (4.2% vs. 10.9%, p<0.001), including lower rates of surgical complications (2.2% vs 8.0%, p<0.001) and wound complications (1.9% vs. 4.8%, p=0.005) compared to MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications. Conclusion: OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared to MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.

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Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

Ku,

Desai,

Singhal

et al. 2024

J Reconstr Microsurg

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Clinical and patient-reported outcomes in women offered oncoplastic breast-conserving surgery as an alternative to mastectomy: ANTHEM multicentre prospective cohort study

Davies,

Johnson,

Conefrey

et al. 2024

British Journal of Surgery

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Background Oncoplastic breast-conserving surgery may be a better option than mastectomy, but high-quality comparative evidence is lacking. The aim of the ANTHEM study (ISRCTN18238549) was to explore clinical and patient-reported outcomes in a multicentre cohort of women offered oncoplastic breast-conserving surgery as an alternative to mastectomy with or without immediate breast reconstruction. Methods Women with invasive/pre-invasive breast cancer who were offered oncoplastic breast-conserving surgery with volume replacement or displacement techniques to avoid mastectomy were recruited prospectively. Demographic, operative, oncological, and 3- and 12-month complication data were collected. The proportion of women choosing oncoplastic breast-conserving surgery and the proportion in whom breast conservation was successful were calculated. Participants completed the validated BREAST-Q questionnaire at baseline, 3 months after surgery, and 12 months after surgery. Questionnaires were scored according to the developers’ instructions and scores for each group were compared over time. Results In total, 362 women from 32 UK breast units participated, of whom 294 (81.2%) chose oncoplastic breast-conserving surgery. Of the oncoplastic breast-conserving surgery patients in whom postoperative margin status was reported, 210 of 255 (82.4%) had clear margins after initial surgery and only 10 (3.9%) required completion mastectomy. Major complications were significantly more likely after immediate breast reconstruction. Women having oncoplastic breast-conserving surgery with volume displacement techniques reported significant improvements in baseline ‘satisfaction with breasts’ and ‘psychosocial well-being’ scores at 3 and 12 months, but both oncoplastic breast-conserving surgery groups reported significant decreases in ‘physical well-being: chest’ at 3 and 12 months. Conclusion Oncoplastic breast-conserving surgery allows greater than 95% of women to avoid mastectomy, with lower major complication rates than immediate breast reconstruction, and may improve satisfaction with outcome. Oncoplastic breast-conserving surgery should be offered as an alternative to mastectomy in all women in whom it is technically feasible.

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Establishment and Validation survival prediction models for T1 locally advanced breast cancer after breast conservation surgery versus mastectomy

Qian,

Shen,

Liu

et al. 2024

Preprint

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Previous reports had shown that the survival rate of total mastectomy (TM) was better than that of breast-conserving surgery (BCS). This study established survival prediction models for T1 LABC mastectomy and BCS, and obtained the risk factors for OS of different surgical procedures, so as to provide a basis for clinicians to individualized treatment.Cases with pathologically confirmed T1 breast cancer (BC) between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were identified. COX regression analysis was used to analyze the relationship between LABC TM, BCS and each factor, and the hazard ratio (HR) and 95% confidence interval (95%CI) were calculated to determine the possible influencing factors. The significant factors from multivariate COX regression were included in the model and then the nomogram was drawn. The receiver operating characteristic (ROC) curve of the model was drawn, and the area under the curve (AUC) and its 95% CI were calculated. Hosmer-Lemeshow goodness-of-fit test was performed. The results were validated in the validation group. The 5-year overall survival (OS) and breast cancer specific survival (BCSS) of BCS were higher than those of TM. Age, race, histological grade, N stage, molecular typing, chemotherapy and radiotherapy (RT) were correlated with 5-year OS of BCS, and age, race, pathological type, histological grade, human epidermal growth factor receptor-2 (Human epidermal growth factor receptor 2, HER2) status, N stage, molecular typing, chemotherapy and RT were related to 5-year OS of TM. The predictive nomogram was established using the above predictors, and the AUC of the modeling group was 0.743 (BCS 5-year OS) and 0.718 (TM 5-year OS), respectively. All models were well validated in the validation group. This study found that the survival rate of BCS group was better than that of TM group, and it indicated the effect of tumor size on BCS survival, while lymph node status was not a risk factor for BCS, BCS could be considered for LABC patients with small masses and more lymph node metastases. However, the risk of death after BCS in patients with N3, triple-negative and upper-inner quadrant primary tumors was higher than that in other groups, and BCS should be cautious in these patients.

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Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis

Cited by 4 publications

References 120 publications

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer

Clinical and patient-reported outcomes in women offered oncoplastic breast-conserving surgery as an alternative to mastectomy: ANTHEM multicentre prospective cohort study

Establishment and Validation survival prediction models for T1 locally advanced breast cancer after breast conservation surgery versus mastectomy

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