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. 2023 Jul 11:13:1178230.
doi: 10.3389/fonc.2023.1178230. eCollection 2023.

Breast-conserving surgery versus mastectomy for treatment of breast cancer after neoadjuvant chemotherapy

Yu-Chun Song  1 , Zhou Huang  1   2 , Hui Fang  1 , Yu Tang  1 , Hao Jing  1 , Yong-Wen Song  1 , Jing Jin  1   3 , Yue-Ping Liu  1 , Bo Chen  1 , Yuan Tang  1 , Shu-Nan Qi  1 , Ning-Ning Lu  1 , Ning Li  1 , Ye-Xiong Li  1 , Shu-Lian Wang  1
Affiliations

Breast-conserving surgery versus mastectomy for treatment of breast cancer after neoadjuvant chemotherapy

Yu-Chun Song et al. Front Oncol. .

Abstract

Background: To compare recurrence and survival outcomes between breast-conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT).

Methods: The data of 730 patients who underwent NACT between 2000 and 2014 were retrospectively reviewed. A total of 104 (14.2%) patients received BCS and 626 (85.8%) received mastectomy. Locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were analyzed using the Kaplan-Meier method. The impact of BCS versus mastectomy on outcomes was assessed by multivariate Cox models. Inverse probability of treatment weighting (IPTW) was used to balance covariates between the two groups.

Results: The median follow-up of BCS and mastectomy groups were 86.5 and 87.4 months, respectively. There were significant differences in distribution of most baseline characteristics between two groups. Compared with those who underwent mastectomy, the patients with BCS had similar 5-year LRR, DM, and DFS rates, but had significantly higher 5-year BCSS (98.9% vs. 90.4%, P = 0.005) and OS (98.9% vs. 90.1%, P = 0.003) rates. Multivariate analysis also showed that BCS significantly improved BCSS (HR = 0.27, 95% CI: 0.08-0.85, P = 0.025) and OS (HR = 0.25, 95% CI: 0.08-0.79, P = 0.018). After IPTW adjustment, the LRR, DM, DFS, BCSS and OS between two groups had no significant differences.

Conclusions: The recurrence and survival outcomes are comparable with BCS and mastectomy. Thus, BCS is a safe treatment option for selected breast cancer patients after NACT.

Keywords: breast cancer; breast-conserving surgery; mastectomy; neoadjuvant chemotherapy; oncological outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Comparison of LRR, DM, DFS, BCSS, and OS between the BCS and mastectomy groups before and after IPTW analysis. LRR (A), DM (C), DFS (E), BCSS (G), and OS (I) before IPTW analysis. LRR (B), DM (D), DFS (F), BCSS (H), and OS (J) after IPTW analysis. LRR, Locoregional recurrence; DM, distant metastasis; DFS, disease-free survival; BCSS, Breast cancer–specific survival; OS, overall survival; IPTW, inverse probability of treatment weighting.
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