10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study
- PMID: 27344114
- DOI: 10.1016/S1470-2045(16)30067-5
10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study
Abstract
Background: Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery plus radiotherapy might be overestimated. In this study, we aimed to evaluate 10 year overall and breast cancer-specific survival after breast-conserving surgery plus radiotherapy compared with mastectomy in Dutch women with early breast cancer.
Methods: In this population-based study, we selected all women from the Netherlands Cancer Registry diagnosed with primary, invasive, stage T1-2, N0-1, M0 breast cancer between Jan 1, 2000, and Dec 31, 2004, given either breast-conserving surgery plus radiotherapy or mastectomy, irrespective of axillary staging or dissection or use of adjuvant systemic therapy. Primary outcomes were 10 year overall survival in the entire cohort and breast cancer-specific survival in a representative subcohort of patients diagnosed in 2003 with characteristics similar to the entire cohort. We estimated breast cancer-specific survival by calculating distant metastasis-free and relative survival for every tumour and nodal category. We did multivariable Cox proportional hazard analysis to estimate hazard ratios (HRs) for overall and distant metastasis-free survival. We estimated relative survival by calculating excess mortality ratios using life tables of the general population. We did multiple imputation to account for missing data.
Findings: Of the 37 207 patients included in this study, 21 734 (58%) received breast-conserving surgery plus radiotherapy and 15 473 (42%) received mastectomy. The 2003 representative subcohort consisted of 7552 (20%) patients, of whom 4647 (62%) received breast-conserving surgery plus radiotherapy and 2905 (38%) received mastectomy. For both unadjusted and adjusted analysis accounting for various confounding factors, breast-conserving surgery plus radiotherapy was significantly associated with improved 10 year overall survival in the whole cohort overall compared with mastectomy (HR 0·51 [95% CI 0·49-0·53]; p<0·0001; adjusted HR 0·81 [0·78-0·85]; p<0·0001), and this improvement remained significant for all subgroups of different T and N stages of breast cancer. After adjustment for confounding variables, breast-conserving surgery plus radiotherapy did not significantly improve 10 year distant metastasis-free survival in the 2003 cohort overall compared with mastectomy (adjusted HR 0·88 [0·77-1·01]; p=0·07), but did in the T1N0 subgroup (adjusted 0·74 [0·58-0·94]; p=0·014). Breast-conserving surgery plus radiotherapy did significantly improve 10 year relative survival in the 2003 cohort overall (adjusted 0·76 [0·64-0·91]; p=0·003) and in the T1N0 subgroup (adjusted 0·60 [0·42-0·85]; p=0·004) compared with mastectomy.
Interpretation: Adjusting for confounding variables, breast-conserving surgery plus radiotherapy showed improved 10 year overall and relative survival compared with mastectomy in early breast cancer, but 10 year distant metastasis-free survival was improved with breast-conserving surgery plus radiotherapy compared with mastectomy in the T1N0 subgroup only, indicating a possible role of confounding by severity. These results suggest that breast-conserving surgery plus radiotherapy is at least equivalent to mastectomy with respect to overall survival and may influence treatment decision making for patients with early breast cancer.
Funding: None.
Copyright © 2016 Elsevier Ltd. All rights reserved.
Comment in
-
The mastectomy myth.Lancet Oncol. 2016 Aug;17(8):1035-1037. doi: 10.1016/S1470-2045(16)30219-4. Epub 2016 Jun 22. Lancet Oncol. 2016. PMID: 27344113 No abstract available.
-
[Breast-conserving surgery plus adjuvant radiotherapy better than mastectomy? : The 10-year survival data from the Netherlands].Strahlenther Onkol. 2017 Apr;193(4):344-346. doi: 10.1007/s00066-017-1111-3. Strahlenther Onkol. 2017. PMID: 28246698 German. No abstract available.
Similar articles
-
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.Breast Cancer Res Treat. 2016 Dec;160(3):511-521. doi: 10.1007/s10549-016-4012-8. Epub 2016 Oct 11. Breast Cancer Res Treat. 2016. PMID: 27730424
-
Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial.Lancet Oncol. 2017 Feb;18(2):259-268. doi: 10.1016/S1470-2045(17)30011-6. Epub 2017 Jan 14. Lancet Oncol. 2017. PMID: 28094198 Clinical Trial.
-
Postmastectomy radiation and recurrence patterns in breast cancer patients younger than age 35 years: a population-based cohort.Ann Surg Oncol. 2014 Feb;21(2):395-400. doi: 10.1245/s10434-013-3319-5. Epub 2013 Oct 22. Ann Surg Oncol. 2014. PMID: 24145994
-
Updates in the treatment of ductal carcinoma in situ of the breast.Curr Opin Obstet Gynecol. 2016 Feb;28(1):49-58. doi: 10.1097/GCO.0000000000000237. Curr Opin Obstet Gynecol. 2016. PMID: 26694830 Review.
-
Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy.Breast. 2015 Jun;24(3):175-81. doi: 10.1016/j.breast.2015.02.002. Epub 2015 Feb 23. Breast. 2015. PMID: 25728282 Review.
Cited by
-
Evaluation of quality of life and socio-emotional impact of oncological treatment among patients with breast cancer.J Med Life. 2024 Mar;17(3):341-352. doi: 10.25122/jml-2024-0238. J Med Life. 2024. PMID: 39044938 Free PMC article.
-
Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis.BJS Open. 2024 May 8;8(3):zrae040. doi: 10.1093/bjsopen/zrae040. BJS Open. 2024. PMID: 38758563 Free PMC article.
-
A meta-analysis of randomized controlled trials comparing breast-conserving surgery and mastectomy in terms of patient survival rate and quality of life in breast cancer.Int J Qual Health Care. 2024 May 30;36(2):mzae043. doi: 10.1093/intqhc/mzae043. Int J Qual Health Care. 2024. PMID: 38753325 Free PMC article.
-
A clinical perspective on oncoplastic breast conserving surgery.Transl Breast Cancer Res. 2023 Sep 28;4:29. doi: 10.21037/tbcr-23-40. eCollection 2023. Transl Breast Cancer Res. 2023. PMID: 38751480 Free PMC article. Review.
-
Chest wall perforator flap partial breast reconstruction: a retrospective analysis of surgical, cosmetic and survival outcome.Ecancermedicalscience. 2024 Mar 14;18:1681. doi: 10.3332/ecancer.2024.1681. eCollection 2024. Ecancermedicalscience. 2024. PMID: 38566767 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials