Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status

Boniface, Jana de; Szulkin, Robert; Johansson, Anna L.V.

doi:10.1001/jamasurg.2021.1438

Cited by 154 publications

(102 citation statements)

References 33 publications

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“…This finding is in agreement with the reports of other studies, which are all convincing and uniformly show DFS and/or OS benefits for BCT compared to mastectomy in patients with stage I-II breast cancer (Table 6). Equivalent or improved outcomes with BCT as compared with mastectomy in terms of locoregional control, BCSS, DFS, or OS have been reported regardless of age [14,15], intrinsic breast cancer subtype [48][49][50][51], pathological tumor stage [11,14,15,51], overall breast cancer stage [52], and grade [51]. Recently, a Swedish cohort study using prospectively collected data of women with stage T1-2 N0-2 breast cancer confirmed better survival with BCT vs. mastectomy (irrespective of radiation therapy) even when taking into account comorbidity and socioeconomic status in both node-negative and node-positive disease, pointing out that offering more extensive surgery to patients who are suitable for either breast-conserving surgery or mastectomy is not saving lives [51].…”

Section: Discussionmentioning

confidence: 99%

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.

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Section: Discussionmentioning

confidence: 99%

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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“…At a median follow-up of 6.28 years, they found that breast conservation therapy with RT led to improved survival compared to mastectomy. [12]. These data suggest that RT might confer a survival advantage, perhaps due to abscopal antitumor effects [13].…”

Section: Discussionmentioning

confidence: 99%

Benefit of Adjuvant Chemotherapy in Node-Negative T1a Versus T1b and T1c Triple Negative Breast Cancer

Fasano¹,

Bayard²,

Chen³

et al. 2021

Preprint

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Purpose: National Comprehensive Cancer Network guidelines recommend delivery of adjuvant chemotherapy in node-negative triple negative breast cancer (TNBC) if the tumor is > 1 cm and consideration of adjuvant chemotherapy for T1b but not T1a disease. These recommendations are based upon sparse data regarding the role of adjuvant chemotherapy in T1a and T1b node-negative TNBC. Our objective was to clarify the benefits of chemotherapy for patients with T1N0 TNBC, stratified by tumor size.Methods: We performed a retrospective analysis of survival outcomes in an IRB-approved prospectively-maintained database of TNBC patients treated at two academic institutions in the United States from 1999-2018. Primary tumor size, histology, and nodal status were based upon definitive surgical pathology. Mean follow-up was 5.3 years.Results: 756 TNBC cases were analyzed; 258 T1N0 TNBC patients were identified. Adjuvant chemotherapy was delivered to 30.5% of T1a, 64.7% T1b, and 83.9% T1c (p < 0.0001). Factors associated with delivery of adjuvant chemotherapy were age, histology, high-grade disease, and postoperative adjuvant radiation therapy. At a mean follow-up of 5.3 years, increase in overall survival was associated with use of chemotherapy in patients with T1c disease (93.2% v. 75.2% p = 0.008) but not in those with T1a (100% v. 100% p = 0.3778) or T1b (100% v. 95.8% p = 0.2362) disease.Conclusion: Our data support current guidelines indicating benefit from adjuvant chemotherapy in node-negative TNBC associated with T1c tumors but excellent outcomes were observed in cases of T1a and T1b disease, regardless of whether adjuvant chemotherapy was delivered.

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“…Undoubtedly, BCS is recommended for patients with early BC, due to the oncological equivalence of BCS followed by RT and mastectomy [38]. However, recent population-based studies have reported improved overall survival after BCS plus RT, compared to mastectomy, demonstrating that BCT has significant benefits, even independently of measured confounders [49][50][51]. Indeed, concerns about the surgical oncological equivalence of mastectomy and BCS have emerged and become a starting point for further studies [51].…”

Section: Margin Status In Breast-conserving Surgery and Molecular Subtypes Implicationmentioning

confidence: 99%

“…However, recent population-based studies have reported improved overall survival after BCS plus RT, compared to mastectomy, demonstrating that BCT has significant benefits, even independently of measured confounders [49][50][51]. Indeed, concerns about the surgical oncological equivalence of mastectomy and BCS have emerged and become a starting point for further studies [51]. Evidence has, thus, shown that breast cancer actually consists of a series of genetically distinct diseases each with a different prognosis.…”

Section: Margin Status In Breast-conserving Surgery and Molecular Subtypes Implicationmentioning

confidence: 99%

Breast Cancer Surgery: New Issues

et al. 2021

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Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.

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Survival After Breast Conservation vs Mastectomy Adjusted for Comorbidity and Socioeconomic Status

Cited by 154 publications

References 33 publications

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Benefit of Adjuvant Chemotherapy in Node-Negative T1a Versus T1b and T1c Triple Negative Breast Cancer

Breast Cancer Surgery: New Issues

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