Yi Min, Chavez-MacGregor Mariana, Smith Benjamin D, Mitchell Melissa P, Caudle Abigail S, DeSnyder Sarah M, Kuerer Henry M, Hunt Kelly K
Unit 1434, Breast Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Breast Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2025 Aug 11. doi: 10.1245/s10434-025-18030-0.
The aim of this study was to evaluate trends in the total mastectomy (TM) rates in patients with early stage breast cancer (BC) undergoing surgery first at a single institution and compare overall (OS), distant metastasis-free (DMFS), local-regional recurrence (LRR), and BC-specific (BCSS) survival between lumpectomy followed by radiation (breast-conserving therapy (BCT)) and TM.
A total of 8967 women with clinical stage T1-2, N0-1, M0 BC who underwent upfront surgery from 1 January 2000 to 31 December 2014 were included. TM rates were evaluated. Inverse probability weighting (IPW) based on propensity scores was used to remove confounding in the survival models in the whole cohort and subset analyses (different stage combined with different hormone receptor status).
TM rates increased from 39.7 to 59.9% (P < 0.001) in patients aged ≤ 50 years from 2005 to 2013. At a median follow-up of 6.1 years, after IPW adjustment, patients undergoing BCT or TM with radiation had slightly worse BCSS and similar OS, DMFS, and LRR rates compared with patients who underwent TM alone in the whole cohort. In subset analyses, after IPW adjustment, there were no significant survival differences in OS, BCSS, and DMFS between patients who underwent TM without radiation versus BCT. Among patients with triple-negative BC and stage I disease, those who underwent BCT had a lower LRR rate than those undergoing TM (relative risk (RR), 0.5; P = 0.02).
Our study shows that BCT and TM are equivalent as an initial surgical strategy for patients with early stage breast cancer. These data may help physicians in decision-making for patients who are candidates for either TM or BCT.
本研究的目的是评估在单一机构首次接受手术的早期乳腺癌（BC）患者中全乳切除术（TM）率的趋势，并比较保乳手术加放疗（保乳治疗（BCT））与TM之间的总生存期（OS）、无远处转移生存期（DMFS）、局部区域复发（LRR）和乳腺癌特异性生存期（BCSS）。
纳入2000年1月1日至2014年12月31日期间接受初次手术的8967例临床分期为T1-2、N0-1、M0的BC女性患者。评估TM率。在整个队列和亚组分析（不同分期与不同激素受体状态相结合）的生存模型中，采用基于倾向评分的逆概率加权（IPW）来消除混杂因素。
2005年至2013年，年龄≤50岁的患者TM率从39.7%增至59.9%（P<0.001）。中位随访6.1年，经IPW调整后，在整个队列中，接受BCT或TM加放疗的患者与单纯接受TM的患者相比，BCSS略差，而OS、DMFS和LRR率相似。在亚组分析中，经IPW调整后，未接受放疗的TM患者与BCT患者在OS、BCSS和DMFS方面无显著生存差异。在三阴性BC和I期疾病患者中，接受BCT的患者LRR率低于接受TM的患者（相对风险（RR），0.5；P=0.02）。
我们的研究表明，对于早期乳腺癌患者，BCT和TM作为初始手术策略是等效的。这些数据可能有助于医生为TM或BCT候选患者进行决策。
