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Meta-Analysis
. 2017 Oct;96(43):e8367.
doi: 10.1097/MD.0000000000008367.

Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis

Yixuan Sun  1 , Mingjuan Liao, Liu He, Chenfang Zhu
Affiliations
Meta-Analysis

Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis

Yixuan Sun et al. Medicine (Baltimore). 2017 Oct.

Abstract

Background: The application of breast-conserving surgery (BCS) on patients with locally advanced breast cancer (LABC) with good response to neoadjuvant chemotherapy (NACT) still remains controversial. The objective in this study is to analyze the safety of BCS in the management of LABC in patients with good response to NACT.

Methods: We searched the electronic databases of Medline (Pubmed) and Cochrane Library for reports on local recurrence (LR), regional recurrence (RR), distant recurrence (DR), 5-year disease-free survival (DFS) or 5-year overall survival (OS) in patients with LABC receiving BCS or mastectomy (MT) and with good response to NACT. Based on the research results, we conducted a meta-analysis using Review Manager 5.3.

Results: Our study showed that 16 studies with a combined total of 3531 patients, of whom 1465 patients underwent BCS, whereas 2066 patients underwent MT. There was no significant heterogeneity among these studies (Q statistic: P = .88; I = 0%). Patients with good response to NACT showed no significant difference in LR and RR [odd ratio (OR) = 0.83; 95% confidence interval (CI): 0.60-1.15; P = .26; OR = 0.56; 95% CI: 0.33-0.93; P = .03], while we figured out a lower DR (OR = 0.51; 95% CI: 0.42-0.63; P < .01), a higher DFS (OR = 2.35; 95% CI: 1.84 to 3.01, P < .01) and a higher OS (OR = 2.12; 95% CI: 1.51 to 2.98, P < .01) in BCS compared with MT.

Conclusion: This meta-analysis concluded that BCS was a safe surgery for patients with LABC and had good response to NACT.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
A flow diagram of the search progress.
Figure 2
Figure 2
A funnel plot of the 13 included studies that reported local recurrence (LR).
Figure 3
Figure 3
A Forest plot of the pooled odd ratio (OR) of local recurrence (LR) for the BCS and MT group. BCS = breast-conserving surgery, CI = confidence interval, MT = mastectomy.
Figure 4
Figure 4
A Forest plot of the pooled odd ratio (OR) of regional recurrence (RR) for the BCS and MT group. BCS = breast-conserving surgery, CI = confidence interval, MT = mastectomy.
Figure 5
Figure 5
A Forest plot of the pooled odd ratio (OR) of distant recurrence (DR) for the BCS and MT group. BCS = breast-conserving surgery, CI = confidence interval, MT = mastectomy.
Figure 6
Figure 6
A Forest plot of the pooled odd ratio (OR) of disease-free survival (DFS) for the BCS and mastectomy (MT) group. BCS = breast-conserving surgery, CI = confidence interval.
Figure 7
Figure 7
A Forest plot of the pooled odd ratio (OR) of overall survival (OS) for the BCS and mastectomy (MT) group. BCS = breast-conserving surgery, CI = confidence interval.
See this image and copyright information in PMC

References

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