Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini, Stefanie; Reitz, D.; Pazos, Montserrat; Schönecker, S.; Braun, Michael; Harbeck, Nadia; Matuschek, Christiane; Bölke, Edwin; Ganswindt, Ute; Alongi, Filippo; Niyazi, Maximilian; Belka, Claus

doi:10.3390/cancers11020160

Cited by 77 publications

(54 citation statements)

References 42 publications

(59 reference statements)

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“…48,49 Given the preliminary evidence of univariate association between time to DR and TG-ETP and TG-peak levels, we further A worse prognosis in terms of disease-free and overall survival rates has already been reported in patients who underwent mastectomy alone compared with breast conserving surgery plus radiotherapy. [50][51][52][53][54] In comparison to mastectomy, after breast-conserving surgery plus radiotherapy both axillary and distant recurrence rates decrease. The reason why breast-conserving surgery is favored over mastectomy is considered to be related to the effect of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Thrombin generation predicts early recurrence in breast cancer patients

Marchetti

Giaccherini

Masci

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Cancer patients present with a hypercoagulable state often associated with poor disease prognosis. Objectives This study aims to evaluate whether thrombin generation (TG), a global coagulation test, may be a useful tool to improve the identification of patients at high risk of early disease recurrence (ie, E‐DR within 2 years) after breast cancer surgery. Patients/Methods A cohort of 522 newly diagnosed patients with surgically resected high‐risk breast cancer were enrolled in the ongoing prospective HYPERCAN study. TG potential was measured in plasma samples collected before starting systemic chemotherapy. Significant predictive hemostatic and clinic‐pathological parameters were identified in the derivation cohort by Cox regression analysis. A risk prognostic score for E‐DR was generated in the derivation and tested in the validation cohort. Results After a median observation period of 3.4 years, DR occurred in 51 patients, 28 of whom were E‐DR. E‐DR subjects presented with the highest TG values as compared to both late‐DR (from 2 to 5 years) and no relapse subjects (P < .01). Multivariate analysis in the derivation cohort identified TG, mastectomy, triple negative and Luminal B HER2‐neg molecular subtypes as significant independent predictors for E‐DR, which were utilized to generate a risk assessment score. In the derivation and validation cohorts, E‐DR rates were 2.3% and 0% in the low‐risk, 10.1% and 6.3% in the intermediate‐risk, and 18.2% and 16.7%, in the high‐risk categories, respectively. Conclusions Inclusion of TG in a risk‐assessment model for E‐DR significantly helps the identification of operated breast cancer patients at high risk of very early relapse.

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Section: Discussionmentioning

confidence: 99%

Thrombin generation predicts early recurrence in breast cancer patients

Marchetti

Giaccherini

Masci

et al. 2020

Journal of Thrombosis and Haemostasis

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“…We con rmed that the BCT group has a higher long-term recurrence risk than the MAS and MAS + RT groups; this result sheds some light on what has been a long-disputed issue in the literature. A large observational study in Germany between 1998 and 2014 reported that BCT allows better local control (HR: 1.52; 95% CI: 1.09-2.11) than MAS [14]. In addition, the BCT cohort had a lower 10-year cumulative incidence of lymph node recurrence (2.0% vs. 5.8%, p < 0.001), lower 10-year distant-metastasis-free survival (85.5% vs. 89.4%, p = 0.013), and better 10-year overall survival (85.3% vs. 79.3%, p < 0.001) than the MAS cohort [14].…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term recurrence of early-stage invasive ductal carcinoma in middle-aged and old women with different treatments: A nationwide population-based cohort study

Kao

Hsu

et al. 2020

Preprint

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Background Most new cases and the highest mortality rates of breast cancer occur among middle-aged and old women. The recurrence rate of early-stage invasive ductal carcinoma (IDC) among women aged ≥ 50 years and receiving different treatments remains unclear. Methods Therefore, this study was conducted to determine these rates. We used Surveillance, Epidemiology, and End Results (SEER) data for this nationwide population-based cohort study. All women aged ≥ 50 years and diagnosed with early-stage IDC between 2000 and 2015 were identified and divided into three treatment groups, namely, breast conservation therapy (BCT), mastectomy alone (MAS), and mastectomy with radiation therapy (MAS + RT). The recurrence rates of IDC among these groups were then compared. Results The BCT group had a lower short-term recurrence risk than the MAS and MAS + RT groups (hazard ratio [HR]: 1.00 vs. 2.90 [95% CI: 1.36–2.66] vs. 2.07 [95% CI: 0.97–4.44]); however, the BCT group also had a higher long-term recurrence risk than MAS and MAS + RT groups (HR: 1.00 vs. 0.30 [95% CI: 0.26–0.35] vs. 0.43 [95% CI: 0.30–0.63]). The high long-term recurrence rate of the BCT group was especially prominent at the 10- and 15-year follow-ups. Conclusion The results provide valuable evidence of the most reliable treatment strategy for this population. Further studies including more variables and validation in other countries are warranted to confirm our findings.

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“…Adjuvant radiation therapy (RT) offers a significant benefit in preventing local recurrences and improves cancer-specific survival in patients undergoing breastconserving therapy for early-stage breast cancer [1,2]. Over the past decade the evaluation of hypofractionated treatment protocols has been of major interest in modern breast radiotherapy [3].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional surface imaging in breast cancer: a new tool for clinical studies?

Koban

Etzel

et al. 2020

Radiat Oncol

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Background: Three-dimensional Surface Imaging (3DSI) is a well-established method to objectively monitor morphological changes in the female breast in the field of plastic surgery. In contrast, in radiation oncology we are still missing effective tools, which can objectively and reproducibly assess and document adverse events in breast cancer radiotherapy within the framework of clinical studies. The aim of the present study was to apply structuredlight technology as a non-invasive and objective approach for the documentation of cosmetic outcome and early effects of breast radiotherapy as a proof of principle. Methods: Weekly 3DSI images of patients receiving either conventionally fractionated radiation treatment (CF-RT) or hypofractionated radiation treatment (HF-RT) were acquired during the radiotherapy treatment and clinical follow-up. The portable Artec Eva scanner (Artec 3D Inc., Luxembourg) recorded 3D surface images for the analysis of breast volumes and changes in skin appearance. Statistical analysis compared the impact of the two different fractionation regimens and the differences between the treated and the contralateral healthy breast. Results: Overall, 38 patients and a total of 214 breast imaging sessions were analysed. Patients receiving CF-RT showed a significantly higher frequency of breast erythema compared to HF-RT (93.3% versus 34.8%, p = 0.003) during all observed imaging sessions. Moreover, we found a statistically significant (p < 0.05) volumetric increase of the treated breast of the entire cohort between baseline (379 ± 196 mL) and follow-up imaging at 3 months (437 ± 224 mL), as well as from week 3 of radiotherapy (391 ± 198 mL) to follow-up imaging. In both subgroups of patients undergoing either CF-RT or HF-RT, there was a statistically significant increase (p < 0.05) in breast volumes between baseline and 3 months follow-up. There were no statistically significant skin or volumetric changes of the untreated healthy breasts. Conclusions: This is the first study utilizing 3D structured-light technology as a non-invasive and objective approach for the documentation of patients receiving breast radiotherapy. 3DSI offers potential as a non-invasive tool to objectively and precisely monitor the female breast in a radiooncological setting, allowing clinicians to objectively distinguish outcomes of different therapy modalities.

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Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Cited by 77 publications

References 42 publications

Thrombin generation predicts early recurrence in breast cancer patients

Thrombin generation predicts early recurrence in breast cancer patients

Short- and long-term recurrence of early-stage invasive ductal carcinoma in middle-aged and old women with different treatments: A nationwide population-based cohort study

Three-dimensional surface imaging in breast cancer: a new tool for clinical studies?

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