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. 2022 Oct 5;3(4):e205.
doi: 10.1097/AS9.0000000000000205. eCollection 2022 Dec.

Breast-Conserving Surgery or Mastectomy?: Impact on Survival

Peer Christiansen  1 , Marco Mele  2 , Anne Bodilsen  3 , Nicola Rocco  4 , Robert Zachariae  5
Affiliations

Breast-Conserving Surgery or Mastectomy?: Impact on Survival

Peer Christiansen et al. Ann Surg Open. .

Abstract

The early randomized controlled trials revealed no differences in survival between breast-conserving surgery (BCS) and mastectomy. However, breast cancer treatment has undergone changes, and the results of recent population-based registry studies suggest superior long-term survival after BCS. To explore the current evidence, a systematic review and meta-ana lysis of population-based observational studies from 2010 and onward was conducted.

Methods: A literature search was conducted in the PubMed, Embase, and Cochrane databases to identify relevant literature. Keywords included "mastectomy," "breast conserving surgery," and "survival." The identified studies were narratively reviewed and effect sizes (hazard ratios [HRs]) for overall (OS) and breast cancer-specific survival (BCSS) were combined with random-effects models.

Results: A total of 30 reports were included in the review, and results from 25 studies were included in the meta-analyses. Compared with mastectomy, BCS was associated with better OS (HR = 1.34 [1.20-1.51]; N = 1,311,600) and BCSS (HR = 1.38 [1.29-1.47]; N = 494,267). Selected subgroups of patients, based on lymph node status, age (<50 years/≥50 years), and radiation therapy after mastectomy (±), all showed better overall survival after BCS. The number (range 4-12) and type of prognostic variables adjusted for in the survival analyses of the studies did not statistically significantly moderate the differences in survival between BCS and mastectomy.

Conclusions: The combined findings from large population-based studies indicate that BCS is associated with survival benefit compared with mastectomy, suggesting that BCS be the recommended treatment of early breast cancer (T1-2N0-1M0) if a radical lumpectomy can be performed.

Keywords: BCS; breast cancer specific survival; breast conserving surgery; breast conserving surgery vs. mastectomy; mastectomy; survival.

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Figures

FIGURE 1.
FIGURE 1.
Flowchart describing the literature search through the databases of PubMed, Embase, and Cochrane.
FIGURE 2.
FIGURE 2.
Forest plots showing meta-analysis of survival data in population-based independent cohorts of breast cancer patients. (A) Overall survival. The 13 studies included 1,311,600 patients. (B) Breast cancer-specific survival. Fourteen studies with 494,267 patients.
FIGURE 3.
FIGURE 3.
Forest plots showing comparisons in overall survival between BCS and mastectomy without (–RT) or with radiation therapy (+RT). BCS indicates breast-conserving surgery; RT, radiation therapy.
FIGURE 4.
FIGURE 4.
Forest plots showing comparisons in breast cancer-specific survival between BCS and mastectomy without (–RT) or with radiation therapy (+RT). BCS indicates breast-conserving surgery; RT, radiation therapy.
See this image and copyright information in PMC

References

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