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. 2023 Jan;225(1):84-92.
doi: 10.1016/j.amjsurg.2022.09.029. Epub 2022 Sep 22.

The role of tumor phenotype in the surgical treatment of early-stage breast cancer

Marguerite M Rooney  1 , Samantha M Thomas  2 , Mahsa Taskindoust  1 , Rachel A Greenup  3 , Laura H Rosenberger  4 , E Shelley Hwang  4 , Jennifer K Plichta  5
Affiliations

The role of tumor phenotype in the surgical treatment of early-stage breast cancer

Marguerite M Rooney et al. Am J Surg. 2023 Jan.

Abstract

Background: We investigated whether tumor phenotype influences surgical decision-making, and how that may impact overall survival (OS) for early-stage breast cancer.

Methods: Women aged 18-69 with cT0-2/cN0/cM0 breast cancer in the National Cancer Database (2010-2017) were included. A generalized logistic model was used to identify factors associated with surgery type. A Kaplan-Meier curve was used to visualize unadjusted OS, and the log-rank test was used to test for differences in OS between surgery types.

Results: Of 597,149 patients, 58% underwent lumpectomy with radiation (BCT), 25% unilateral mastectomy (UM), and 17% bilateral mastectomy (BM). After adjustment, HER2+ and triple-negative (TN) tumors were less likely to undergo UM than BCT, versus hormone receptor-positive tumors (OR = 0.881, 95% CI = 0.860-0.903; OR = 0.485, 95% CI = 0.470-0.501). UM and BM had worse 5-year OS versus BCT (UM: 0.926, vs BM: 0.952, vs BCT: 0.960).

Conclusions: BCT is increasingly used to treat HER2+ and TN tumors. More extensive surgery is not associated with better survival outcomes, regardless of tumor phenotype.

Keywords: Breast cancer; Breast surgery; Mastectomy; Practice patterns; Tumor phenotype.

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Conflict of interest statement

Declaration of competing interest

Figures

Figure 1.
Figure 1.
Breast surgery type by year of diagnosis for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=597149); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 1.
Figure 1.
Breast surgery type by year of diagnosis for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=597149); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 1.
Figure 1.
Breast surgery type by year of diagnosis for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=597149); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 1.
Figure 1.
Breast surgery type by year of diagnosis for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=597149); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 2.
Figure 2.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=338571); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 2.
Figure 2.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=338571); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 2.
Figure 2.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=338571); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 2.
Figure 2.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) for (A) all patients (N=338571); or those with (B) HR+ (ER+ and/or PR+)/HER2− (N=449435) disease; (C) HER2+ (N=80727); or (D) triple negative (ER−/PR−/HER2−) disease (N=66987). HR: hormone receptor. ER: estrogen receptor. PR: progesterone receptor. HER2: human-epidermal-growth-factor-receptor-2.
Figure 3.
Figure 3.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) stratified by tumor grade: (A) grade 1 (N=146408); (B) grade 2 (N=259854); (C) grade 3 (N=164704).
Figure 3.
Figure 3.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) stratified by tumor grade: (A) grade 1 (N=146408); (B) grade 2 (N=259854); (C) grade 3 (N=164704).
Figure 3.
Figure 3.
Overall survival by breast surgery type for women ages 18–69 with cT0–2/cN0/cM0 breast cancer in the National Cancer Database (diagnosed 2010–2017) stratified by tumor grade: (A) grade 1 (N=146408); (B) grade 2 (N=259854); (C) grade 3 (N=164704).
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