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Comparative Study
. 2015 Nov 24;6(37):40127-40.
doi: 10.18632/oncotarget.5394.

Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: A NCDB analysis

Kai Chen  1   2   3 , Jieqiong Liu  1   2   3 , Liling Zhu  1   2 , Fengxi Su  1   2 , Erwei Song  1   2 , Lisa K Jacobs  3
Affiliations
Comparative Study

Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: A NCDB analysis

Kai Chen et al. Oncotarget. .

Abstract

Purpose: Recent studies have revealed that breast-conserving surgery (BCS) with radiotherapy (RT) led to better survival than mastectomy in some populations. We compared the efficacy of BCS+RT and mastectomy using the National Cancer Database (NCDB, USA).

Results: A total of 160,880 patients with a median follow-up of 43.4 months were included. The respective 8-year OS values were 86.5%, 72.3% and 70.4% in the BCS+RT, mastectomy alone and mastectomy+RT group, respectively (P < 0.001). After exclusion of patients with comorbidities, mastectomy (alone or with RT) remained associated with a lower OS in N0 and N1 patients. However, the OS of mastectomy+RT was equivalent to BCS+RT in N2-3 patients. Among patients aged 50 or younger, the OS benefit of BCS+RT over mastectomy alone was statistically significant (HR1.42, 95% CI 1.16-1.74), but not clinically significant (<5%) in N0 patients, whereas in N2-3 patients, the OS of BCS+RT was equivalent to mastectomy+RT (85.2% vs. 84.8%). The results of the propensity analysis were similar.

Methods: Non-metastatic breast cancers in the NCDB from 2004-2011 were identified.The Kaplan-Meier method, Coxregression and propensity score analysis were used to compare the overall survival (OS) among patients with BCS+RT, mastectomy alone and mastectomy+RT.

Conclusions: BCS+RT resulted in improved OS compared with mastectomy ± RT in N0 and N1 patients. In N2-3 patients, BCS+RT has an OS similar to mastectomy+RT when patients with comorbidities were excluded. Among patients aged 50 or younger, the OS of BCS+RT is equivalent to mastectomy ± RT.

Keywords: breast cancer; breast-conserving surgery; mastectomy.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Kaplan-Meier survival analysis of the entire population A–C. and in patients with “Less/No comorbid conditions” D–F. Analysis were performed separately in N0 (A, D), N1 (B, E) and N2–3 (C, F) patients
Figure 2
Figure 2. A. Improvement of OS in N0, N2–3 patients. The benefit of 5-year and 8-year OS was calculated by comparing BCS+RT with mastectomy alone in N0 patients, and with mastectomy+RT in N2–3 patients
B. Improvement of OS in N1 patients. The survival benefit of BCS+RT over mastectomy alone or with RT was shown as indicated. BCS, breast-conserving surgery; M, Mastectomy; RT, radiation therapy.
Figure 3
Figure 3. Kaplan-Meier survival analysis of the patients with age ≤50 A–C. and age > 50 D–F. respectively
Analysis was performed separately in N0 (A, D), N1 (B, E) and N2–3 (C, F) patients
See this image and copyright information in PMC

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