Breast-Conserving Therapy for Early-Stage Breast Cancer in Chinese Women: A Meta-Analysis of Case-Control Studies

Cai, Xiaopeng; Liu, Xu; Yu, Haitao; Li, Ji‐Guang; Zheng, Xinyu

doi:10.1159/000336969

Cited by 3 publications

(4 citation statements)

References 19 publications

(14 reference statements)

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“…This is consistent with the results of several randomized clinical trials published from 1980 to 2008 that showed no significant difference in OS ( 2 , 28 - 37 ) and DFS ( 2 , 28 , 34 , 36 ) between stage I-II (T1-2, N0-1) IBC patients who underwent BCS plus radiation and radical or modified radical mastectomy at 5-20 years of follow-up. Similar to the results of this study, a meta-analysis including 25 Chinese Case-Control Studies from 2004 to 2010 showed that there was no significant difference between 3-year and 5-year OS of IBC patients with early stage in the BCS group and the MT group ( 38 ). We believe that large randomized clinical trials can better eliminate confounders and compare the impact of the two surgical methods on the survival more objectively.…”

Section: Discussionsupporting

confidence: 85%

Breast-conserving therapy versus mastectomy for breast cancer: a ten-year follow-up single-center real-world study

Li¹,

Zheng²,

Wu³

et al. 2022

Gland Surg

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Background: The rapid development of early diagnostic methods and systematic treatment for breast cancer have shed lights on the insight of prognosis of breast-conserving therapy versus mastectomy.However, there are relatively few studies with long-term follow-up, large patient cohort and under the contemporary setting in China on the subject of survival of patients undergoing breast conserving therapy versus mastectomy.Methods: Data on the cases of breast-conserving therapy and mastectomy for breast cancer from October 1, 2005 to September 31, 2010 were retrieved from the breast cancer database of Chinese PLA General Hospital. The clinicopathological characteristics of patients were compared by chi-square test or Fisher's exact test. Breast cancer-specific survival, disease-free survival, local recurrence-free survival, loco-regional recurrence-free survival, and distant metastasis-free survival were calculated and compared by Kaplan-Meier survival analysis and log-rank test firstly. And then Cox Proportional-Hazards model was used for multivariate analysis.Results: There were 296 patients in the breast-conserving surgery group and 675 patients in the mastectomy group. For patients with invasive breast cancer in the entire cohort, the 10-year breast cancerspecific survival rate of patients in the breast-conserving surgery group at stage I-II was significantly higher than that of the mastectomy group. However, surgical method was not an independent prognostic factor for breast cancer-specific survival, disease-free survival and local recurrence-free survival. Moreover, N stage and luminal B-like subtype were independent prognostic factors for the breast cancer-specific survival of invasive breast cancer in the entire cohort.Conclusions: This study suggests that there is no significant difference in breast cancer-specific survival between breast cancer patients undergoing breast-conserving surgery and mastectomy after adjusting for confounding factors. Lymph node staging is the major risk factor affecting patients' survival. In this case, choosing patients with smaller tumor size, avoiding patients with stage N3, and removing a smaller volume of breast tissue including tumors while ensuring negative margins may reduce the patient's risk of local recurrence and loco-regional recurrence.

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Section: Discussionsupporting

confidence: 85%

Breast-conserving therapy versus mastectomy for breast cancer: a ten-year follow-up single-center real-world study

Li¹,

Zheng²,

Wu³

et al. 2022

Gland Surg

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“…Cai X with his coleagues found that BCT was the better choice than MT for Chinese women with earlystage breast cancer eventhough they worked on non rendomized trials. 8 The similar results were found by Vila J and colleagues. For them, mastectomy provides better OS compared to breast conserving surgery followed by whole breast radiotherapy in early breast cancer patients aged 40 years or younger.…”

Section: Risk Of Biassupporting

confidence: 78%

“…Another meta-analysis performed with non-randomised studies reported that the 3 year or 5 year overall survival, was not statistically different between the BCT group and the mastectomy group. 8 For this meta-analysis, the included studies reported the outcome as dichotomous data.…”

mentioning

confidence: 99%

Comparison of Survival Outcomes between Early Breast Cancer Patients who Underwent Mastectomy and Patients Treated by Breast Conserving Therapy: A Meta Analysis

Manirakiza

Laurent

Manirakiza

2022

EAHRJ

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Background: Early stage of breast cancer requires mastectomy or breast conserving therapy. However, there are disagreements regarding the outcome of these two types of therapies in term of overall survivals. Objectives: The first aim of this meta-analysis was to assess the overall survival between patients who underwent mastectomy and those treated by breast conserving therapy. The second was to evaluate the influence of the follow up period on overall survival between the patients who benefited mastectomy and those who under went breast conservative therapy. Methods: We systematically searched on PubMed and Cochrane library all published randomized trials comparing mastectomy with breast conserving therapy and assessing overall survival. Results: Using dichotomous data, there was no significant difference between mastectomy and BCT(OR:0.99; 95% CI:0.93-1.06; P:0.86). This was the same in subgroup analysis based on period of follow up. Their ORs and CI were (OR:0.97; 95% CI:0.81-1.18; P:0.79), (OR:1.01; 95% CI:0.90-1.13; P:0.87) and (OR:1.04; 95% CI:0.93-1.16; P:0.46) respectively for up to 5 years or less, between 5 and 10 years and more than 10 years of follow up. Using generic inverse variance, there was no significant difference between mastectomy and BCT, (HR:1.01; 95% CI:0.98-1.04; P:0.71). In subgroup analysis based on period of follow up, there was no significant difference between mastectomy and BCT. Their HRs, CI and P-value were (HR:1.01; 95% CI:0.951-1.07; P:0.79), (HR:0.98; 95% CI:0.92-1.04; P:0.51) and (HR:1.02; 95% CI:0.97-1.07; P:0.40) respectively for up to 5 years or less, between 5 and 10 years and more than 10 years of follow up. Conclusion: This meta-analysis demonstrated that there was no significant difference between patients with early stage breast cancer when they are treated by mastectomy or breast consevative therapy in term of overall survival. Additionnally, the follow up period had no any influence on the both types of surgery in term of overall survival. Therefore, we suggest that breast conservative therapy or mastectomy should be discussed between the care team and the patient, taking into account the financial means available to the patient, especially in low-income countries, the benefits of the surgery and the patient’s choices.

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“…LRFS and DRFS were not significantly different between the BCS and MT groups [ 34 , 35 ] as well as like some studies said, following neoadjuvant chemotherapy [ 36 , 37 ]. However, some researchers found that BCS patients had higher LR after NAC, perhaps because the surgical margins became difficult to accurately assess [ 38 ], some studies reported contrary results that MT group had higher LR rate compared with BCS group [ 18 , 39 ].…”

Section: Discussionmentioning

confidence: 76%

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

Dai

Chen

et al. 2017

World J Surg Onc

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BackgroundWith limited sample sizes and single-institution designs, how complete response (CR) after neoadjuvant chemotherapy (NAC) influences breast conserving surgery (BCS) and its value in prognosis are not clear.MethodsA systematic research review was conducted using electronic database. The rate of clinical complete response (cCR) in BCS after NAC and these pathological CR (PCR) and non-pCR BCS patients’ local recurrence-free survival (LRFS), distance recurrence-free survival (DRFS), overall survival (OS), and disease-free survival (DFS) rates were collected. A pooled analysis was performed using a fixed or random effects model and a Q test to determine heterogeneity.ResultsSixteen studies with a total of 4639 patients were included. The pooled data revealed that cCR patients compared with non-cCR patients had significantly higher rates of BCS, with a summary estimate odds ratios (OR) of 4.54 (95% CI 2.03–10.17). The pooled data revealed that BCS patients who achieved pCR after NAC had significantly lower rates of LRFS (RR = 0.59, 95% CI 0.38–0.92) and DRFS (RR = 0.27, 95% CI 0.13–0.55). Better DFS (RR = 0.09, 95% CI 0.04–0.25) and OS (RR = 0.36, 95% CI 0.03–3.90) were also seen, but OS was not significantly different.ConclusionsThe rate of successful BCS is higher in the cCR group than in the non-cCR group, means cCR after NAC can encourage patients to receive BCS. The achievement of pCR after NAC in BCS patients was associated with a good prognosis in terms of LRFS and DRFS, but its value in DFS and OS requires further investigation.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1273-6) contains supplementary material, which is available to authorized users.

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Breast-Conserving Therapy for Early-Stage Breast Cancer in Chinese Women: A Meta-Analysis of Case-Control Studies

Cited by 3 publications

References 19 publications

Breast-conserving therapy versus mastectomy for breast cancer: a ten-year follow-up single-center real-world study

Breast-conserving therapy versus mastectomy for breast cancer: a ten-year follow-up single-center real-world study

Comparison of Survival Outcomes between Early Breast Cancer Patients who Underwent Mastectomy and Patients Treated by Breast Conserving Therapy: A Meta Analysis

Oncological outcome of complete response after neoadjuvant chemotherapy for breast conserving surgery: a systematic review and meta-analysis

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