Comparison of Survival Outcomes of Breast-Conserving Surgery Plus Radiotherapy with Mastectomy in Early Breast Cancer Patients: Less Is More?

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2025 Feb 26

PMID 40002186

Authors

Chularat Duangkaew

Areewan Somwangprasert

Kirati Watcharachan

Phanchaporn Wongmaneerung

Wasana Ko-Iam

Issara Kaweewan

Chagkrit Ditsatham

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the survival outcomes of early-stage breast cancer patients treated with breast-conserving therapy (BCT) and mastectomy.

Method: This retrospective study includes 1330 early-stage breast cancer patients treated at Chiang Mai University (CMU) hospital, using data from the Chiang Mai Cancer Registry between 2004 and 2015. Information pertinent to patients and their treatment was collected for analysis. Time-to-event analysis was performed using Kaplan-Meier methods.

Results: The baseline characteristics of 1330 patients showed significant differences between the BCT and mastectomy groups in terms of age, tumor size, and tumor location. BCT patients were younger, had smaller tumors, and exhibited less nodal involvement. Propensity score matching created a balanced cohort of 534 patients where differences persisted in age and tumor size. Univariate analysis revealed significant survival associations for BCT, younger age, and smaller tumor size. Multivariate analysis confirmed these factors, with BCT showing an adjusted hazard ratio (HR) of 0.58 (95% CI: 0.36-0.93; = 0.023) compared to mastectomy. Kaplan-Meier survival analysis demonstrated a significant survival advantage for BCT, particularly in HER2-enriched and triple-negative subtypes. The 15-year overall survival was 80.01% in the BCT group versus 64.33% in the mastectomy group ( < 0.001).

Conclusions: This study reveals key differences between outcomes following breast-conserving therapy (BCT) and mastectomy patients, including age and tumor characteristics. BCT showed improved overall survival, particularly in HER2-enriched and triple-negative breast cancers. However, our study's limitations may affect the results. These findings suggest that BCT may offer survival benefits for specific subtypes, highlighting the importance of personalized treatment approaches.

References

van Dongen J, Voogd A, Fentiman I, LeGrand C, Sylvester R, Tong D . Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000; 92(14):1143-50. DOI: 10.1093/jnci/92.14.1143. View

Langlands F, Horgan K, Dodwell D, Smith L . Breast cancer subtypes: response to radiotherapy and potential radiosensitisation. Br J Radiol. 2013; 86(1023):20120601. PMC: 3608055. DOI: 10.1259/bjr.20120601. View

Speers C, Pierce L . Postoperative Radiotherapy After Breast-Conserving Surgery for Early-Stage Breast Cancer: A Review. JAMA Oncol. 2016; 2(8):1075-82. DOI: 10.1001/jamaoncol.2015.5805. View

Mokbel K . Unlocking the Power of the Homing Phenomenon: Why Breast Conserving Surgery Outshines Mastectomy in Overall Survival. Clin Breast Cancer. 2023; 24(2):85-92. DOI: 10.1016/j.clbc.2023.10.003. View

Chen Y, Jiang L, Gao B, Cheng Z, Jin J, Yang K . Survival and disease-free benefits with mastectomy versus breast conservation therapy for early breast cancer: a meta-analysis. Breast Cancer Res Treat. 2016; 157(3):517-25. DOI: 10.1007/s10549-016-3830-z. View

Gradishar W, Moran M, Abraham J, Abramson V, Aft R, Agnese D . Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2024; 22(5):331-357. DOI: 10.6004/jnccn.2024.0035. View

Yuan Y, Liu P, Li F, Yang Y, Yang W, Fan L . Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study. BMC Surg. 2023; 23(1):298. PMC: 10548734. DOI: 10.1186/s12893-023-02181-6. View

Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst M . Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients. BMJ. 2015; 351:h4901. PMC: 4595560. DOI: 10.1136/bmj.h4901. View

Wang J, Shi M, Ling R, Xia Y, Luo S, Fu X . Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial. Radiother Oncol. 2011; 100(2):200-4. DOI: 10.1016/j.radonc.2011.07.007. View

10.

Hartmann-Johnsen O, Karesen R, Schlichting E, Nygard J . Survival is Better After Breast Conserving Therapy than Mastectomy for Early Stage Breast Cancer: A Registry-Based Follow-up Study of Norwegian Women Primary Operated Between 1998 and 2008. Ann Surg Oncol. 2015; 22(12):3836-45. PMC: 4595537. DOI: 10.1245/s10434-015-4441-3. View

11.

Veronesi U, Luini A, Galimberti V, Zurrida S . Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg. 1994; 18(1):70-5. DOI: 10.1007/BF00348194. View

12.

De la Cruz Ku G, Karamchandani M, Chambergo-Michilot D, Narvaez-Rojas A, Jonczyk M, Principe-Meneses F . Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients. Ann Surg Oncol. 2022; 29(10):6163-6188. DOI: 10.1245/s10434-022-12133-8. View

13.

Clavarezza M, Mustacchi G, Casadei Gardini A, Del Mastro L, de Matteis A, Riccardi F . Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study. BMC Cancer. 2012; 12:216. PMC: 3433340. DOI: 10.1186/1471-2407-12-216. View

14.

Vasilyeva E, Nichol A, Bakos B, Barton A, Goecke M, Lam E . Breast conserving surgery combined with radiation therapy offers improved survival over mastectomy in early-stage breast cancer. Am J Surg. 2023; 231:70-73. DOI: 10.1016/j.amjsurg.2023.05.005. View

15.

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

16.

Wee H, Canfell K, Chiu H, Choi K, Cox B, Bhoo-Pathy N . Cancer screening programs in South-east Asia and Western Pacific. BMC Health Serv Res. 2024; 24(1):102. PMC: 10797973. DOI: 10.1186/s12913-023-10327-8. View

17.

Fisher B, Anderson S, Bryant J, Margolese R, Deutsch M, Fisher E . Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347(16):1233-41. DOI: 10.1056/NEJMoa022152. View

18.

Ditsatham C, Sripan P, Chaiwun B, Klunklin P, Tharavichitkul E, Chakrabandhu S . Breast Cancer Subtypes in Northern Thailand and Barriers to satisfactory survival outcomes. BMC Cancer. 2022; 22(1):1147. PMC: 9641818. DOI: 10.1186/s12885-022-10196-0. View

19.

Park K, Loibl S, Sohn J, Park Y, Jiang Z, Tadjoedin H . Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer. ESMO Open. 2024; 9(5):102974. PMC: 11145753. DOI: 10.1016/j.esmoop.2024.102974. View

20.

Jacobson J, DANFORTH D, Cowan K, DAngelo T, Steinberg S, Pierce L . Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995; 332(14):907-11. DOI: 10.1056/NEJM199504063321402. View