The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer: a population-based study from the SEER 18 database

Abstract

Breast-conserving surgery (BCS) including radiotherapy (RT) has been demonstrated to provide at least equivalent prognosis to mastectomy in early-stage breast cancer. However, studies on triple-negative breast cancer (TNBC) patients are relatively scarce. The current population-based study aimed to investigate the distinct outcomes between BCS+RT and mastectomy in patients with TNBC. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 11,514 female TNBC cases diagnosed during the years 2010-2013. Those patients were subdivided into BCS+RT (5,469) and mastectomy groups (6,045), and we conducted a survival comparison between the two groups. The endpoints were breast cancerspecific survival (BCSS) and overall survival (OS). In the overall cohort, patients with BCS+RT exhibited distinctly better breast cancer-specific survival (BCSS) (log-rank, p < 0.001) and overall survival (OS) (log-rank, p < 0.001) than did mastectomy patients. When stratifying the TNBC patients according to age, histology grade, TNM stage, tumor size, and lymph node (LN) status, most patients in the BCS+RT group presented with better survival than did the patients in the mastectomy group, except for the grade I (log-rank, p = 0.830, both BCSS and OS) and stage I (log-rank, BCSS, p = 0.127; OS, p = 0.093) patients. In addition, after adjusting for confounding variables by multivariable Cox proportional hazard analysis, BCS+RT still tended to present with higher BCSS and OS. In conclusion, from our study on SEER data, BCS+RT displayed elevated BCSS and OS in TNBC patients compared to mastectomy, at least equally. Our study provided further evidence for surgeons that BCS with RT is available for TNBC patients.

A population‐based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple‐negative breast cancer

“…Surgery was the main form of treatment (received by 96%) in patients with stage I-III TNBC. Patients underwent lumpectomy or mastectomy at rates of 63% and 33%, respectively, which demonstrates support for breast-conserving surgery comparable to 13 or greater than 8,33 that reported in other cohorts.…”

“…[3][4][5] Population-based studies focused on TNBC are sparse and the majority address only clinical characteristics and outcomes. 3,[5][6][7][8][9][10][11][12][13][14][15][16] While older data report direct health-care costs for Ontario BC patients by cancer stage, 17 there are no published reports on resource utilization in an Ontario TNBC cohort by cancer stage. We sought to assess the occurrence, management, and resource utilization according to early versus de novo metastatic disease in Ontario women diagnosed with TNBC.…”

Meta-analysis of the impact of progesterone receptor status on oncological outcomes in oestrogen receptor-positive breast cancer

“…Given these results, it is likely that PgR negativity should be taken into consideration when planning treatment. It is unlikely that reverting to more radical surgery in these patients will overcome the challenges of its poorer prognosis, as comparisons of breast‐conserving therapy versus mastectomy, and wider versus narrower margins in the most biologically aggressive triple‐negative breast cancers have demonstrated no difference in locoregional recurrence according to type of surgery performed. Patients with ER+PgR– disease should, however, be considered for more aggressive neoadjuvant or adjuvant therapy, including systemic chemotherapy.…”

<p>Effect of Clinical and Treatment Factors on Survival Outcomes of Triple Negative Breast Cancer Patients</p>

“…An analysis of the Surveillance, Epidemiology, and End Results (SEER) population-based database showed that breast-conserving surgery combined with radiation therapy was associated with better breast cancer-specific survival and OS compared to mastectomy. 18 On multivariate analysis, advanced nodal status and tumor size were significant factors for adverse survival. A Chinese study of 308 patients, with immunohistochemically-confirmed TNBC, showed that breast-conserving surgery was not associated with increased ipsilateral tumor recurrence compared to a non-TNBC subtype cohort.…”