Li Wanheng, Zheng Yiqiong, Wu Huan, Li Xiru
First Clinical Medical School, Southern Medical University, Guangzhou, China.
Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Gland Surg. 2022 Jul;11(7):1148-1165. doi: 10.21037/gs-22-142.
The rapid development of early diagnostic methods and systematic treatment for breast cancer have shed lights on the insight of prognosis of breast-conserving therapy versus mastectomy. However, there are relatively few studies with long-term follow-up, large patient cohort and under the contemporary setting in China on the subject of survival of patients undergoing breast conserving therapy versus mastectomy.
Data on the cases of breast-conserving therapy and mastectomy for breast cancer from October 1, 2005 to September 31, 2010 were retrieved from the breast cancer database of Chinese PLA General Hospital. The clinicopathological characteristics of patients were compared by chi-square test or Fisher's exact test. Breast cancer-specific survival, disease-free survival, local recurrence-free survival, loco-regional recurrence-free survival, and distant metastasis-free survival were calculated and compared by Kaplan-Meier survival analysis and log-rank test firstly. And then Cox Proportional-Hazards model was used for multivariate analysis.
There were 296 patients in the breast-conserving surgery group and 675 patients in the mastectomy group. For patients with invasive breast cancer in the entire cohort, the 10-year breast cancer-specific survival rate of patients in the breast-conserving surgery group at stage I-II was significantly higher than that of the mastectomy group. However, surgical method was not an independent prognostic factor for breast cancer-specific survival, disease-free survival and local recurrence-free survival. Moreover, N stage and luminal B-like subtype were independent prognostic factors for the breast cancer-specific survival of invasive breast cancer in the entire cohort.
This study suggests that there is no significant difference in breast cancer-specific survival between breast cancer patients undergoing breast-conserving surgery and mastectomy after adjusting for confounding factors. Lymph node staging is the major risk factor affecting patients' survival. In this case, choosing patients with smaller tumor size, avoiding patients with stage N3, and removing a smaller volume of breast tissue including tumors while ensuring negative margins may reduce the patient's risk of local recurrence and loco-regional recurrence.
乳腺癌早期诊断方法和系统治疗的快速发展，为保乳治疗与乳房切除术的预后洞察提供了线索。然而，在中国，关于保乳治疗与乳房切除术患者生存情况的研究相对较少，缺乏长期随访、大样本队列且处于当代环境。
从中国人民解放军总医院乳腺癌数据库中检索2005年10月1日至2010年9月31日期间乳腺癌保乳治疗和乳房切除术病例的数据。采用卡方检验或Fisher精确检验比较患者的临床病理特征。首先通过Kaplan-Meier生存分析和对数秩检验计算并比较乳腺癌特异性生存、无病生存、局部无复发生存、区域无复发生存和远处无转移生存。然后使用Cox比例风险模型进行多因素分析。
保乳手术组有296例患者，乳房切除术组有675例患者。对于整个队列中的浸润性乳腺癌患者，保乳手术组Ⅰ-Ⅱ期患者的10年乳腺癌特异性生存率显著高于乳房切除术组。然而，手术方式并非乳腺癌特异性生存、无病生存和局部无复发生存的独立预后因素。此外，N分期和腔面B样亚型是整个队列中浸润性乳腺癌患者乳腺癌特异性生存的独立预后因素。
本研究表明，在调整混杂因素后，保乳手术和乳房切除术的乳腺癌患者在乳腺癌特异性生存方面无显著差异。淋巴结分期是影响患者生存的主要危险因素。在这种情况下，选择肿瘤较小的患者，避免N3期患者，在确保切缘阴性的同时切除包括肿瘤在内的较小体积乳腺组织，可能会降低患者局部复发和区域复发的风险。
