Yang Zhen, Wu Tianhao, Chen Pengyu, Li Luan, Leng Kaiming, Dong Ruipeng, Shi Guangjun
Qingdao Municipal Hospital, Qingdao University, Qingdao, People's Republic of China.
Qingdao Hiser Hospital Affiliated of Qingdao University, Shibei District, Qingdao, Shandong Province, China.
Ann Surg Oncol. 2025 Apr;32(4):2554-2568. doi: 10.1245/s10434-024-16726-3. Epub 2024 Dec 30.
The current study aimed to examine second breast cancer (SBC) risks associated with breast-conserving surgery (BCS) and unilateral mastectomy among breast cancer (BC) survivors.
The study enrolled patients with diagnoses of stages I to III BC who underwent surgery between 2000 and 2019. Fine-Gray competing risk regression models were used to estimate the cumulative incidence of SBC and to evaluate the associations between clinical factors and SBC development. Poisson regression analysis was performed to assess the risk for SBC after BCS compared with mastectomy by age and latency period. The Kaplan-Meier method was applied to examine survival between patients undergoing breast-conserving therapy (BCT) and those undergoing mastectomy for SBC.
Among 740,349 patients, 467,480 underwent BCS, and 272,869 underwent mastectomy. The 10-year cumulative incidence of mastectomy was 3.77% for SBC and 2.11% for BCS. Compared with mastectomy, BCS was associated with a significantly higher risk of LR and a modestly elevated risk of contralateral breast cancer (CBC). The significant risk factors for SBC were age at initial BC diagnosis, race, marital status, year of diagnosis, tumor size, histology, molecular subtype, cancer stage, metropolitan status, type of surgery, and radiotherapy. Dynamic risk assessments showed that the relative risk of SBC after BCS versus mastectomy decreased with advancing age, but increased with longer follow-up periods.
This cohort study showed that BC survivors undergoing BCS have a higher risk of SBC than those undergoing mastectomy. With the ongoing evolution of surgical options, achieving optimal long-term outcomes necessitates a more comprehensive assessment that balances oncologic efficacy with patient-centered outcomes.
本研究旨在探讨保乳手术（BCS）和单侧乳房切除术与乳腺癌（BC）幸存者发生第二原发性乳腺癌（SBC）风险之间的关系。
本研究纳入了2000年至2019年间接受手术的Ⅰ至Ⅲ期BC患者。采用Fine-Gray竞争风险回归模型来估计SBC的累积发病率，并评估临床因素与SBC发生之间的关联。通过Poisson回归分析，按年龄和潜伏期评估BCS后与乳房切除术后发生SBC的风险。应用Kaplan-Meier方法来检验接受保乳治疗（BCT）的患者与接受乳房切除术治疗SBC的患者之间的生存率。
在740349例患者中，467480例接受了BCS，272869例接受了乳房切除术。乳房切除术后10年SBC的累积发病率为3.77%，BCS为2.11%。与乳房切除术相比，BCS与局部复发（LR）风险显著较高以及对侧乳腺癌（CBC）风险适度升高相关。SBC的显著危险因素包括初次BC诊断时的年龄、种族、婚姻状况、诊断年份、肿瘤大小、组织学、分子亚型、癌症分期、大都市状况、手术类型和放疗。动态风险评估显示，BCS后与乳房切除术后SBC的相对风险随年龄增长而降低，但随随访时间延长而增加。
这项队列研究表明，接受BCS的BC幸存者发生SBC的风险高于接受乳房切除术的患者。随着手术选择的不断发展，要实现最佳的长期结果，需要进行更全面的评估，以平衡肿瘤学疗效和以患者为中心的结果。
