Skip to main content

Advertisement

SpringerLink
Log in

Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Our previous study demonstrated breast-conserving surgery with radiation therapy (BCT) to be at least equivalent to mastectomy in T1-2N0-1 breast cancer. Yet, 10-year survival rates after BCT and mastectomy with radiation therapy (MAST) in T1-2N2 breast cancer specifically have not been examined. Our study aimed to determine 10-year overall (OS), relative (RS), and distant metastasis-free survival (DMFS) in T1-2N2 breast cancer after BCT and MAST, stratified for T category.

Methods

All women diagnosed with primary invasive T1-2N2 breast cancer in 2000–2004, treated with BCT or MAST, both with axillary dissection and RT, were selected from the Netherlands Cancer Registry. Ten-year OS and DMFS were estimated using multivariable Cox regression. Excess mortality ratios (EMR) were calculated to estimate RS, using life tables of the general population. OS and RS were determined on the whole cohort, and DMFS on the 2003 cohort with completed follow-up. Missing data were imputed.

Results

Of 3071 patients, 1055 (34.4 %) received BCT and 2016 (65.7 %) MAST. BCT and MAST showed equal 10-year OS and RS. After stratification, BCT was significantly associated with improved 10-year OS [HRadjusted 0.82 (95 % CI 0.71–0.96)] and RS (EMRadjusted 0.81 (95 % CI 0.67–0.97]) in T2N2, but not in T1N2. Ten-year DMFS was equal for both treatments [HRadjusted 0.87 (95 % CI 0.64–1.18)] in the 2003 cohort (n = 594), which was representative for the full cohort.

Conclusion

BCT showed at least equal 10-year OS, RS, and DMFS compared to MAST. These results confirm that BCT is a good treatment option in T1-2N2 breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

BCSS:

Breast cancer-specific survival

BCT:

Breast-conserving surgery with radiation therapy

CI:

Confidence interval

DMFS:

Distant metastasis-free survival

EMR:

Excess mortality ratio

HR:

Hazard ratio

MAST:

Mastectomy with radiation therapy

RCT:

Randomized controlled trial

RS:

Relative survival

RT:

Radiation therapy

T category:

Pathologically staged tumor category (T1 = 0–2 cm, T2 = 2–5 cm)

References

  1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232

    Article  PubMed  Google Scholar 

  3. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92(14):1143–1150

    Article  PubMed  Google Scholar 

  4. Hershman DL, Wright JD (2012) Comparative effectiveness research in oncology methodology: observational data. J Clin Oncol 30(34):4215–4222

    Article  PubMed  Google Scholar 

  5. van Maaren MC, de Munck L, de Bock GH, Jobsen JJ, van Dalen T, Linn SC, Poortmans P, Strobbe LJ, Siesling S (2016) 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol. doi:10.1016/S1470-2045(16)30067-5

    PubMed  Google Scholar 

  6. Fisher S, Gao H, Yasui Y, Dabbs K, Winget M (2015) Survival in stage I-III breast cancer patients by surgical treatment in a publicly-funded healthcare system. Ann Oncol 26(6):1161–1169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hofvind S, Holen A, Aas T, Roman M, Sebuodegard S, Akslen LA (2015) Women treated with breast conserving surgery do better than those with mastectomy independent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol 41(10):1417–1422

    Article  CAS  PubMed  Google Scholar 

  8. Onitilo AA, Engel JM, Stankowski RV, Doi SA (2014) Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res 13(2):65–73

    Article  PubMed  Google Scholar 

  9. Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK (2015) Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: a NCDB analysis. Oncotarget 6(37):40127–40140

    PubMed  PubMed Central  Google Scholar 

  10. Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, Foster R, Gardner B, Lerner H, Margolese R et al (1983) Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer 52(9):1551–1557

    Article  CAS  PubMed  Google Scholar 

  11. NABON (2016). Dutch guideline breast cancer (Landelijke richtlijn mammacarcinoom). http://www.oncoline.nl/mammacarcinoom. Accessed 19 May 2016

  12. Moossdorff M, van Roozendaal LM, Strobbe LJ, Aebi S, Cameron DA, Dixon JM, Giuliano AE, Haffty BG, Hickey BE, Hudis CA et al (2014) Maastricht delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst 106(12):dju288

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gourgou-Bourgade S, Cameron D, Poortmans P, Asselain B, Azria D, Cardoso F, A’Hern R, Bliss J, Bogaerts J, Bonnefoi H et al (2015) Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (definition for the assessment of time-to-event endpoints in cancer trials). Ann Oncol 26(5):873–879

    Article  CAS  PubMed  Google Scholar 

  14. Hakulinen T, Seppa K, Lambert PC (2011) Choosing the relative survival method for cancer survival estimation. Eur J Cancer 47(14):2202–2210

    Article  PubMed  Google Scholar 

  15. Corazziari I, Quinn M, Capocaccia R (2004) Standard cancer patient population for age standardising survival ratios. Eur J Cancer 40(15):2307–2316

    Article  PubMed  Google Scholar 

  16. Narod SA (2012) Tumor size predicts long-term survival among women with lymph node-positive breast cancer. Curr Oncol 19(5):249–253

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Skelly AC, Dettori JR, Brodt ED (2012) Assessing bias: the importance of considering confounding. Evid Based Spine Care J 3(1):9–12

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yin W, Di G, Zhou L, Lu J, Liu G, Wu J, Shen K, Han Q, Shen Z, Shao Z (2009) Time-varying pattern of recurrence risk for Chinese breast cancer patients. Breast Cancer Res Treat 114(3):527–535

    Article  PubMed  Google Scholar 

  19. Jatoi I, Tsimelzon A, Weiss H, Clark GM, Hilsenbeck SG (2005) Hazard rates of recurrence following diagnosis of primary breast cancer. Breast Cancer Res Treat 89(2):173–178

    Article  PubMed  Google Scholar 

  20. Dai Kubicky C, Mongoue-Tchokote S (2013) Prognostic significance of the number of positive lymph nodes in women with T1-2N1 breast cancer treated with mastectomy: should patients with 1, 2, and 3 positive lymph nodes be grouped together? Intl J Radiat Oncol Biol Phys 85(5):1200–1205

    Article  Google Scholar 

  21. Henson KE, Jagsi R, Cutter D, McGale P, Taylor C, Darby SC (2016) Inferring the effects of cancer treatment: divergent results from early breast cancer trialists’ collaborative group meta-analyses of randomized trials and observational data from SEER registries. J Clin Oncol 34(8):803–809

    Article  CAS  PubMed  Google Scholar 

  22. Chavez-MacGregor M, Giordano SH (2016) Randomized clinical trials and observational studies: is there a battle? J Clin Oncol 34(8):772–773

    Article  PubMed  Google Scholar 

  23. Lee KJ, Carlin JB (2012) Recovery of information from multiple imputation: a simulation study. Emerg Themes Epidemiol 9(1):3

    Article  PubMed  PubMed Central  Google Scholar 

  24. Covelli AM, Baxter NN, Fitch MI, Wright FC (2014) Increasing mastectomy rates-the effect of environmental factors on the choice for mastectomy: a comparative analysis between Canada and the United States. Ann Surg Oncol 21(10):3173–3184

    Article  PubMed  Google Scholar 

  25. Christante D, Pommier SJ, Diggs BS, Samuelson BT, Truong A, Marquez C, Hansen J, Naik AM, Veto JT, Pommier FR (2010) Using complications associated with post-mastectomy radiation and immediate breast reconstruction to improve surgical decision making. Arch Surg 145(9):873–878

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the Netherlands Cancer Registry for providing the data, and we thank the registration clerks for their effort in gathering data in the Netherlands Cancer Registry.

Author information

Authors and Affiliations

  1. Department of Research, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands

    M. C. van Maaren, L. de Munck & S. Siesling

  2. Department of Radiation Oncology, Medical Spectrum Twente, P.O. Box 50000, 7500 KA, Enschede, The Netherlands

    J. J. Jobsen

  3. Department of Radiation Oncology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    P. Poortmans

  4. Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands

    G. H. de Bock

  5. Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands

    S. Siesling

  6. Department of Surgical Oncology, Canisius Wilhelmina Hospital, P.O. Box 9015, 6500 GS, Nijmegen, The Netherlands

    L. J. A. Strobbe

Authors
  1. M. C. van Maaren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. de Munck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. J. Jobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Poortmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. H. de Bock
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Siesling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. J. A. Strobbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. C. van Maaren.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws in the Netherlands.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Maaren, M.C., de Munck, L., Jobsen, J.J. et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients. Breast Cancer Res Treat 160, 511–521 (2016). https://doi.org/10.1007/s10549-016-4012-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-016-4012-8

Keywords

Search

Navigation