Survival Outcomes of Breast-Conserving Therapy versus Mastectomy in Early-Stage Breast Cancer, Including Centrally Located Breast Cancer: A SEER-Based Study

Abstract

Purpose. This study aims to analyze the survival outcomes of breast cancer (BC) patients, especially centrally located breast cancer (CLBC) patients undergoing breast-conserving therapy (BCT) or mastectomy. Methods. Surveillance, epidemiology, and end results (SEER) data of patients with T1-T2 invasive ductal or lobular breast cancer receiving BCT or mastectomy were reviewed. We used X-tile software to convert continuous variables to categorical variables. Chi-square tests were utilized to compare baseline information. The multivariate logistic regression model was performed to evaluate the relationship between predictive variables and treatment choice. Survival outcomes were visualized by Kaplan–Meier curves and cumulative incidence function curves and compared using multivariate analyses, including the Cox proportional hazards model and competing risks model. Propensity score matching was performed to alleviate the effects of baseline differences on survival outcomes. Result. A total of 180,495 patients were enrolled in this study. The breast preservation rates fluctuated around 60% from 2000 to 2015. Clinical features including invasive ductal carcinoma (IDC), lower histologic grade, smaller tumor size, fewer lymph node metastases, positive ER and PR status, and chemotherapy use were independently correlated with BCT in both BC and CLBC cohorts. In all the classic Cox models and competing risks models, BCT was an independent favorable prognostic factor for BC, including CLBC patients in most subgroups. In addition, despite the low breast-conserving rate compared with tumors located in the other areas, CLBC did not impair the prognosis of BCT patients. Conclusion. BCT is optional and preferable for most early-stage BC, including CLBC patients.

Comparative Effect of Chemotherapy and Non-chemotherapy Treatments on the Survival of Breast Cancer Patients at Different Stages: A SEER Cross-Sectional Based Study

“…In both the BC and CLBC groups, clinical characteristics such as invasive ductal carcinoma (IDC), lower histologic grade, smaller tumor size, fewer lymph node metastases, positive ER and PR status, and chemotherapy treatment were independently linked with BCT. [19] To address potential confounding variables, techniques of propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). The results of the study indicated that elderly women aged over 70 with larger tumor sizes, higher tumor grades, positive lymph nodes, negative hormone receptor status, and an absence of active local therapy might experience favorable prognostic outcomes from chemotherapy.…”

Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

“…Thanks to mammography screening, a growing number of breast tumors are currently diagnosed in preclinical stage or clinical development. As a consequence, breast conserving surgery (BCS) has become the most used surgical treatment for women with early breast cancer 1–3 . Nonetheless, mastectomy continues to remain a surgical option in selected cases.…”

“…As a consequence, breast conserving surgery (BCS) has become the most used surgical treatment for women with early breast cancer. [1][2][3] Nonetheless, mastectomy continues to remain a surgical option in selected cases. In patients undergoing mastectomy, immediate breast reconstruction (IBR) represents a keystone of the surgical treatment strategy.…”

Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study

“…Several researches based on real-world data concluded that BCS may be an alternative for CLBC patients. However, these studies had limitations in the study design, including advanced breast cancer, absence of post-surgical radiotherapy, small sample, and insufficient follow-up, which cannot provide evidence for the utility of BCT in patients with early-stage CLBC [ 14 – 19 ]. Further study is needed to evaluate the long-term oncological safety of BCT in CLBC.…”