Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage II Triple Negative Breast cancer

Recent studies suggest survival benefit of breast conservation over mastectomy. We evaluated distant recurrence (DR) rates after breast-conservation therapy (BCT) versus mastectomy in our community-based cancer institute. A retrospective review of patients undergoing treatment of Stage 0–3 breast ca...

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Bibliographic Details
Published in:	The American journal of surgery Vol. 221; no. 4; pp. 809 - 812
Main Authors:	Macfie, Rebekah, Aks, Cynthia, Panwala, Kathryn, Johnson, Nathalie, Jennifer Garreau
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2021 Elsevier Limited
Subjects:	Biopsy Breast cancer Breast conservation therapy Cancer Cancer therapies Chemotherapy Conservation Female Humans Lymph nodes Lymphatic system Mastectomy Mastectomy, Segmental Middle Aged Neoplasm Recurrence, Local - pathology Neoplasm Staging Population Radiation Radiation therapy Retrospective Studies Subgroups Survival Survival Rate Triple negative Triple Negative Breast Neoplasms - pathology Triple Negative Breast Neoplasms - surgery Tumors Womens health Breast conservation therapy Mastectomy Breast cancer Radiation therapy Triple negative
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Summary:	Recent studies suggest survival benefit of breast conservation over mastectomy. We evaluated distant recurrence (DR) rates after breast-conservation therapy (BCT) versus mastectomy in our community-based cancer institute. A retrospective review of patients undergoing treatment of Stage 0–3 breast cancer from January, 2002 to December, 2011 was performed. We evaluated outcomes between those having BCT versus mastectomy. We reviewed 4876 patients. There was no significant difference in DR between patients undergoing BCT versus mastectomy in DCIS (n = 904; BCS 521, mastectomy 383; DR = 1/521 vs 1/383; p = 0.09), Stage I (n = 2202; BCT 1505, mastectomy 697; DR = 6/1505 vs 17/697; p = 0.98) or Stage III cancer (n = 417; BCT 87, mastectomy 330; DR = 17/87 vs 59/330; p = 0.50). There was significantly less DR in Stage II patients (n = 1353) undergoing BCT vs mastectomy (32/645 vs 64/708; p = 0.003). Subgroup analysis of Stage II TNBC (n = 198) subgroup analysis showed 104 mastectomy and 94 BCT patients. Those in the BCT group had significantly lower rates of DR (6/94 vs 16/104; p= 0.03) and significantly higher survival (81/94 vs 69/104; p = 0.007) than those undergoing mastectomy. Of Stage II TNBC patients with DR there was no difference in age, lymph node status or tumor size (p > 0.05 for all) in BCT versus mastectomy groups; there was a significant difference in radiation status (94/94 vs. 28/104; p < 0.0001). Radiation was associated with worse outcomes in the mastectomy group (HR 2.32; p = 0.04). We found significantly less DR in Stage II patients undergoing BCT vs mastectomy. This benefit includes a survival advantage in patients with TNBC undergoing BCT. We could not identify an explanatory factor. Until the difference is understood eligible patients with TNBC should be encouraged to undergo BCT. •Recent studies suggest survival benefit of breast conservation therapy (BCT) over mastectomy.•We reviewed 4876 patients from 2002 to 2011.•There was significantly less distant recurrence in Stage II patients undergoing BCT vs Mastectomy.•Stage II TNBC patients had both a distant recurrence and overall survival advantage with BCT over mastectomy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/j.amjsurg.2020.04.016