Breast Cancer Research and Treatment

, Volume 160, Issue 3, pp 511–521 | Cite as

Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients

  • M. C. van Maaren
  • L. de Munck
  • J. J. Jobsen
  • P. Poortmans
  • G. H. de Bock
  • S. Siesling
  • L. J. A. Strobbe



Our previous study demonstrated breast-conserving surgery with radiation therapy (BCT) to be at least equivalent to mastectomy in T1-2N0-1 breast cancer. Yet, 10-year survival rates after BCT and mastectomy with radiation therapy (MAST) in T1-2N2 breast cancer specifically have not been examined. Our study aimed to determine 10-year overall (OS), relative (RS), and distant metastasis-free survival (DMFS) in T1-2N2 breast cancer after BCT and MAST, stratified for T category.


All women diagnosed with primary invasive T1-2N2 breast cancer in 2000–2004, treated with BCT or MAST, both with axillary dissection and RT, were selected from the Netherlands Cancer Registry. Ten-year OS and DMFS were estimated using multivariable Cox regression. Excess mortality ratios (EMR) were calculated to estimate RS, using life tables of the general population. OS and RS were determined on the whole cohort, and DMFS on the 2003 cohort with completed follow-up. Missing data were imputed.


Of 3071 patients, 1055 (34.4 %) received BCT and 2016 (65.7 %) MAST. BCT and MAST showed equal 10-year OS and RS. After stratification, BCT was significantly associated with improved 10-year OS [HRadjusted 0.82 (95 % CI 0.71–0.96)] and RS (EMRadjusted 0.81 (95 % CI 0.67–0.97]) in T2N2, but not in T1N2. Ten-year DMFS was equal for both treatments [HRadjusted 0.87 (95 % CI 0.64–1.18)] in the 2003 cohort (n = 594), which was representative for the full cohort.


BCT showed at least equal 10-year OS, RS, and DMFS compared to MAST. These results confirm that BCT is a good treatment option in T1-2N2 breast cancer.


Breast cancer Breast-conserving surgery Mastectomy Radiation therapy Overall survival Relative survival Distant metastasis-free survival 



Breast cancer-specific survival


Breast-conserving surgery with radiation therapy


Confidence interval


Distant metastasis-free survival


Excess mortality ratio


Hazard ratio


Mastectomy with radiation therapy


Randomized controlled trial


Relative survival


Radiation therapy

T category

Pathologically staged tumor category (T1 = 0–2 cm, T2 = 2–5 cm)



We thank the Netherlands Cancer Registry for providing the data, and we thank the registration clerks for their effort in gathering data in the Netherlands Cancer Registry.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws in the Netherlands.

Supplementary material

10549_2016_4012_MOESM1_ESM.pdf (21 kb)
Supplementary material 1 (PDF 21 kb)
10549_2016_4012_MOESM2_ESM.pdf (109 kb)
Supplementary material 2 (PDF 108 kb)
10549_2016_4012_MOESM3_ESM.pdf (57 kb)
Supplementary material 3 (PDF 57 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • M. C. van Maaren
    • 1
  • L. de Munck
    • 1
  • J. J. Jobsen
    • 2
  • P. Poortmans
    • 3
  • G. H. de Bock
    • 4
  • S. Siesling
    • 1
    • 5
  • L. J. A. Strobbe
    • 6
  1. 1.Department of ResearchNetherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands
  2. 2.Department of Radiation OncologyMedical Spectrum TwenteEnschedeThe Netherlands
  3. 3.Department of Radiation OncologyRadboud University Medical CenterNijmegenThe Netherlands
  4. 4.Department of Epidemiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  5. 5.Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical MedicineUniversity of TwenteEnschedeThe Netherlands
  6. 6.Department of Surgical OncologyCanisius Wilhelmina HospitalNijmegenThe Netherlands

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