Breast-conserving surgery linked to high survival outcomes for women with breast cancer

Key takeaways:

• Breast-conserving surgery was linked to high breast cancer survival rates in China.
• Five- and 10-year survival rates were 92.9% and 87.4% for overall survival and 89% and 82.9% for disease-free survival.

Breast-conserving surgery resulted in high overall and disease-free survival rates among patients with breast cancer who underwent surgery in China, according to a cohort study published in JAMA Network Open.

“According to a randomized clinical trial, breast-conserving surgery yields similar prognoses to mastectomy in patients with early-stage breast cancer. Recent studies have also provided evidence that breast-conserving surgery may offer better prognoses than mastectomy,” Gang Liu, MD, from the department of breast surgical oncology at the National Cancer Center, the National Clinical Research Center for Cancer and the Cancer Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues wrote. “However, in China, the breast-conserving surgery rate is low, and there are few studies comparing the prognoses of patients undergoing breast-conserving surgery vs. mastectomy.”

Liu and colleagues conducted a cohort study and a retrospective review from medical records of 14,782 patients (mean age, 51.63 years) with unilateral breast cancer who underwent surgery from January 2009 to September 2017. All patients had a median follow-up period of 7.69 years. Researchers conducted a survival analysis to evaluate overall survival and disease-free survival.

The most prevalent type of breast cancer in the cohort was invasive ductal carcinoma (85.6%). Overall, 6.4% of patients had stage 0, 32% had stage I, 40.5% had stage II, 20.2% had stage III and 0.9% had stage IV breast cancer. Most patients had hormone receptor positivity (75.1%) with 29.1% of patients testing positive for the ERBB2 gene.

In the cohort, 13.3% of patients were hormone receptor-negative and ERBB2-negative, 12.7% were hormone receptor-negative and ERBB2-positive, 57.8% were hormone receptor-positive and ERBB2-negative and 16.2% were hormone receptor-positive and ERBB2-positive.

Breast-conserving surgery was performed for 19.5% of patients, and 9.8% of patients had neoadjuvant chemotherapy. The 5-year overall survival rate for breast-conserving surgery was 92.9% and the 10-year overall survival rate was 87.4%. In addition, the 5-year disease-free survival rate was 89% and the 10-year disease-free survival rate was 82.9%.

Among patients with invasive ductal carcinoma, age, breast-conserving surgery, invasive tumor size, tumor grade, lymphovascular invasion, the number of lymph node metastases, distant metastasis, Ki67 and hormone receptor status were all associated with overall survival in the multivariate analysis. Researchers also noted that invasive tumor size, tumor grade, lymphovascular invasion, the number of lymph node metastases, hormone receptor status and ERBB2 status were associated with disease-free survival.

Breast-conserving surgery had similar survival outcomes in patients with invasive ductal carcinoma as mastectomy.

“We elucidated the histopathological characteristics of these patients and the association between these characteristics and survival outcomes,” the researchers wrote. “Additionally, we found that patients who underwent breast-conserving surgery exhibited potentially superior overall survival, highlighting the need to augment breast-conserving surgery implementation in China.”