Shrestha Pratibha, Hsieh Mei-Chin, Ferguson Tekeda, Peters Edward S, Trapido Edward, Yu Qingzhao, Chu Quyen D, Wu Xiao-Cheng
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center, New Orleans, LA, USA.
Breast Cancer (Auckl). 2024 Sep 23;18:11782234241273666. doi: 10.1177/11782234241273666. eCollection 2024.
Studies in the United States are scarce that assess the survival differences between breast-conserving surgery plus radiation (Breast-Conserving Therapy; BCT) and mastectomy groups using population-based data while accounting for sociodemographic and clinical factors that affect the survival of women with early-stage breast cancer (ESBC).
To assess whether BCT provides superior long-term overall survival (OS) and breast cancer-specific survival (BCSS) compared with mastectomy in women with ESBC, while considering key factors that impact survival.
Cohort study.
We analyzed data on women aged 20 years and older diagnosed with stage I-II breast cancer (BC) in 2004 who received either BCT or mastectomy. The data were collected by 5 state cancer registries through the Centers for Disease Control and Prevention-funded Patterns of Care study. Multivariable Cox proportional hazard models, accounting for sociodemographic and clinical factors, were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Sensitivity analysis involved optimal caliper propensity score (PS) matching to address residual confounding.
Of the 3495 women, 41.5% underwent mastectomy. The 10-year OS and BCSS were 82.7% and 91.1% for BCT and 72.3% and 85.7% for mastectomy, respectively. Adjusted models showed that mastectomy recipients had a 22% higher risk of all-cause deaths (ACD) (HR = 1.22, 95% CI = [1.06, 1.41]) and a 26% higher risk of breast cancer-specific deaths (BCD) (HR = 1.26, 95% CI = [1.02, 1.55]) than BCT recipients. Sensitivity analysis demonstrated that mastectomy was associated with a higher risk of ACD ( < .05) but did not exhibit a statistically significant risk for BCD. Women with HR+/HER2+ (luminal B) or invasive ductal carcinoma BC who underwent mastectomy had higher risks of ACD and BCD compared with BCT recipients, while the hazards for ACD in triple-negative BC did not remain significant after adjusting for covariates.
ESBC BCT recipients demonstrate superior OS and BCSS compared with mastectomy recipients.
在美国，利用基于人群的数据评估保乳手术加放疗（保乳治疗；BCT）与乳房切除术组之间的生存差异，同时考虑影响早期乳腺癌（ESBC）女性生存的社会人口统计学和临床因素的研究很少。
评估在考虑影响生存的关键因素的情况下，与乳房切除术相比，BCT是否能为ESBC女性提供更好的长期总生存（OS）和乳腺癌特异性生存（BCSS）。
队列研究。
我们分析了2004年诊断为I-II期乳腺癌（BC）且年龄在20岁及以上并接受BCT或乳房切除术的女性的数据。这些数据由5个州癌症登记处通过疾病控制和预防中心资助的护理模式研究收集。使用多变量Cox比例风险模型，在考虑社会人口统计学和临床因素的情况下，计算风险比（HR）及95%置信区间（CI）。敏感性分析采用最优卡尺倾向评分（PS）匹配以解决残余混杂问题。
在3495名女性中，41.5%接受了乳房切除术。BCT组的10年总生存率和乳腺癌特异性生存率分别为82.7%和91.1%，乳房切除术组分别为72.3%和85.7%。调整后的模型显示，与接受BCT的患者相比，接受乳房切除术的患者全因死亡（ACD）风险高22%（HR = 1.22，95%CI = [1.06, 1.41]），乳腺癌特异性死亡（BCD）风险高26%（HR = 1.26，95%CI = [1.02, 1.55]）。敏感性分析表明，乳房切除术与较高的ACD风险相关（P <.05），但对BCD未显示出统计学显著风险。与接受BCT的患者相比，接受乳房切除术的HR+/HER2+（管腔B型）或浸润性导管癌BC女性的ACD和BCD风险更高，而在调整协变量后，三阴性乳腺癌的ACD风险不再显著。
与接受乳房切除术的患者相比，ESBC接受BCT的患者表现出更好的总生存率和乳腺癌特异性生存率。
