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Science China Life Sciences

, Volume 61, Issue 12, pp 1528–1536 | Cite as

Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis

  • Kai Chen
  • Zihao Pan
  • Liling Zhu
  • Tingting Hu
  • Min Peng
  • Weijuan Jia
  • Fengxi Su
  • Shunrong Li
  • Erwei Song
Research Paper
  • 63 Downloads

Abstract

Recent observational studies showed that breast-conserving surgery (BCS) resulted in superior survival compared to mastectomy in breast cancer patients. This study compared the clinical outcomes of BCS and mastectomy using propensity score (PS) matching analysis, which had advantages over conventional methods in reducing bias. Nonmetastatic breast cancer patients who underwent BCS and mastectomy were matched 1:1 based on their PS. We used the Kaplan-Meier method and Cox-regression model to estimate the treatment effects. A total of 2,866 patients with a median follow-up time of 67 months were included in the original study population. Although the mastectomy cohort (N=1,219) had more advanced disease compared to the BCS cohort (N=1,647), LRFS was similar between the two groups (93.8% vs. 92.4%, P>0.05). BCS (vs. mastectomy) was associated with improved DFS (73.8% vs. 58.7%, P<0.01) and CSS (91% vs. 78.2%, P<0.01) in the original population. In the PS-matched population (N=1,668), clinicopathological features were equally distributed between the two cohorts. BCS (vs. mastectomy) was not associated with improved DFS (70.7% vs. 66.9%, P>0.05) or CSS (87.5% vs. 84.9%, P>0.05). We found that PS methods reduce bias when estimating treatment effects using observational data. BCS and mastectomy show equivalent outcomes in nonmetastatic breast cancer patients.

Keywords

breast-conserving surgery mastectomy breast cancer propensity score survival 

Notes

Acknowledgements

This work was supported by grants from the National Key Research and Development Program of China (2016YFC1302300), the National Natural Science Foundation of China (81720108029, 81621004, 81490750), Guangdong Science and Technology Department (2016B030229004), Guangzhou Science Technology and Innovation Commission (201803040015). The research is partly supported by Fountain- Valley Life Sciences Fund of University of Chinese Academy of Sciences Education Foundation, and Grant [2013] 163 from the Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of the Guangzhou Bureau of Science and Information Technology.

Supplementary material

11427_2018_9396_MOESM1_ESM.pdf (303 kb)
Supplemental Figure 1
11427_2018_9396_MOESM2_ESM.pdf (30 kb)
Supplemental Figure 2
11427_2018_9396_MOESM3_ESM.doc (29 kb)
Supplementary File 1
11427_2018_9396_MOESM4_ESM.docx (15 kb)
Supplemental Table 1, Propensity score model

References

  1. Abdulkarim, B.S., Cuartero, J., Hanson, J., Deschênes, J., Lesniak, D., and Sabri, S. (2011). Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. JCO 29, 2852–2858.CrossRefGoogle Scholar
  2. Agarwal, S., Pappas, L., Neumayer, L., Kokeny, K., and Agarwal, J. (2014). Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 149, 267–274.CrossRefGoogle Scholar
  3. Badwe, R., Hawaldar, R., Nair, N., Kaushik, R., Parmar, V., Siddique, S., Budrukkar, A., Mittra, I., and Gupta, S. (2015). Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: An open-label randomised controlled trial. Lancet Oncol 16, 1380–1388.CrossRefGoogle Scholar
  4. Black, D.M., Hunt, K.K., and Mittendorf, E.A. (2013). Long term outcomes reporting the safety of breast conserving therapy compared to mastectomy: 20-year results of EORTC 10801. Gland Surg 2, 120–123.Google Scholar
  5. Chen, K., Zeng, Y., Jia, H., Jia, W.J., Yang, H., Rao, N., Song, E., Cox, C. E., and Su, F. (2012). Clinical outcomes of breast-conserving surgery in patients using a modified method for cavity margin assessment. Ann Surg Oncol 19, 3386–3394.CrossRefGoogle Scholar
  6. Chen, K., Liu, J., Zhu, L., Su, F., Song, E., and Jacobs, L.K. (2015). Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: A NCDB analysis. Oncotarget 6, 40127–40140.Google Scholar
  7. Elze, M.C., Gregson, J., Baber, U., Williamson, E., Sartori, S., Mehran, R., Nichols, M., Stone, G.W., and Pocock, S.J. (2017). Comparison of propensity score methods and covariate adjustment. J Am College Cardiology 69, 345–357.CrossRefGoogle Scholar
  8. Fisher, B., Anderson, S., Bryant, J., Margolese, R.G., Deutsch, M., Fisher, E.R., Jeong, J.H., and Wolmark, N. (2002). 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 347, 1233–1241.CrossRefGoogle Scholar
  9. Gao, P., You, L., Wu, D., Shi, A., Miao, Q., Rana, U., Martin, D.P., Du, Y., Zhao, G., Han, B., et al. (2018). Adherence to endocrine therapy among Chinese patients with breast cancer: Current status and recommendations for improvement. PPA 12, 887–897.CrossRefGoogle Scholar
  10. Hartmann-Johnsen, O.J., Karesen, R., Schlichting, E., and Nygard, J.F. (2015). 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 22, 3836–3845.CrossRefGoogle Scholar
  11. Haukoos, J.S., and Lewis, R.J. (2015). The propensity score. JAMA 314, 1637–1638.CrossRefGoogle Scholar
  12. Hwang, E.S., Lichtensztajn, D.Y., Gomez, S.L., Fowble, B., and Clarke, C. A. (2013). Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer 119, 1402–1411.CrossRefGoogle Scholar
  13. Krall, J.A., Reinhardt, F., Mercury, O.A., Pattabiraman, D.R., Brooks, M. W., Dougan, M., Lambert, A.W., Bierie, B., Ploegh, H.L., Dougan, S. K., et al. (2018). The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors in mouse models of dormancy. Sci Transl Med 10, eaan3464.CrossRefGoogle Scholar
  14. Lacy, A.M., García-Valdecasas, J.C., Delgado, S., Castells, A., Taurá, P., Piqué, J.M., and Visa, J. (2002). Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: A randomised trial. Lancet 359, 2224–2229.CrossRefGoogle Scholar
  15. Morrow, M., Harris, J.R., and Schnitt, S.J. (2012). Surgical margins in lumpectomy for breast cancer—bigger is not better. N Engl J Med 367, 79–82.CrossRefGoogle Scholar
  16. Onitilo, A.A., Engel, J.M., Stankowski, R.V., and Doi, S.A. (2014). Survival comparisons for breast conserving surgery and mastectomy revisited: Community experience and the role of radiation therapy. Clin Med Res 13, 65–73.CrossRefGoogle Scholar
  17. Tang, S.S.K., Kaptanis, S., Haddow, J.B., Mondani, G., Elsberger, B., Tasoulis, M.K., Obondo, C., Johns, N., Ismail, W., Syed, A., et al. (2017). Current margin practice and effect on re-excision rates following the publication of the SSO-ASTRO consensus and ABS consensus guidelines: A national prospective study of 2858 women undergoing breast-conserving therapy in the UK and Ireland. Eur J Cancer 84, 315–324.CrossRefGoogle Scholar
  18. van Maaren, M.C., de Munck, L., de Bock, G.H., Jobsen, J.J., van Dalen, T., Linn, S.C., Poortmans, P., Strobbe, L.J.A., and Siesling, S. (2016). 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: A population-based study. Lancet Oncol 17, 1158–1170.CrossRefGoogle Scholar
  19. van Tienhoven, G., Voogd, A.C., Peterse, J.L., Nielsen, M., Andersen, K. W., Mignolet, F., Sylvester, R., Fentiman, I.S., van der Schueren, E., van Zijl, K., et al. (1999). Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC breast cancer cooperative group and the Danish breast cancer cooperative group. Eur J Cancer 35, 32–38.Google Scholar
  20. Veronesi, U., Cascinelli, N., Mariani, L., Greco, M., Saccozzi, R., Luini, A., Aguilar, M., and Marubini, E. (2002). Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347, 1227–1232.CrossRefGoogle Scholar
  21. Yang, H., Jia, W., Chen, K., Zeng, Y., Li, S., Jin, L., Wang, L., Song, E., and Su, F. (2012). Cavity margins and lumpectomy margins for pathological assessment: Which is superior in breast-conserving surgery? J Surg Res 178, 751–757.CrossRefGoogle Scholar

Copyright information

© Science China Press and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kai Chen
    • 1
    • 2
  • Zihao Pan
    • 1
    • 2
    • 3
  • Liling Zhu
    • 1
    • 2
  • Tingting Hu
    • 1
    • 2
  • Min Peng
    • 1
    • 2
  • Weijuan Jia
    • 1
    • 2
  • Fengxi Su
    • 1
    • 2
  • Shunrong Li
    • 1
    • 2
  • Erwei Song
    • 1
    • 2
    • 4
  1. 1.Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
  2. 2.Breast Tumor Center, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
  3. 3.Department of Thoracic-Cardiac Surgery, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
  4. 4.Fountain-Valley Institute for Life Sciences, Guangzhou Institute of Biomedicine and HealthChinese Academy of SciencesGuangzhouChina

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