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Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method

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

Abstract

Purpose

This study aimed to compare the effect of BCT versus mastectomy on the recurrence and survival of different-aged patients, and to investigate whether effects of BCT versus mastectomy on survival of young patients were consistent with those of old patients.

Methods

Data on women with primary invasive breast cancer between 2007 and 2011 were extracted from the institutional database of Breast Center. Disparities in hormone receptor, tumor size, lymph node status, and Her-2 status between BCT and mastectomy groups were adjusted using the propensity score (PS) adjustment method. Patients were divided by age into two groups (≤ 40 years and > 40 years). We assessed proportions of local recurrence (LR), distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) in different-aged groups; this assessment was further stratified by surgical treatment.

Results

A total of 2964 patients were included; 565 (19%) were aged ≤ 40 years. In the entire cohort, hazard ratios (HR) of BCT versus mastectomy for DDFS and DFS were 0.56 (P = 0.029) and 0.55 (P = 0.008), respectively. After PS adjustment, there was no significant difference between BCT and mastectomy in LR, DDFS, DFS and BCSS in the young age group. In the old age group, women who underwent BCT exhibited improved DDFS (HR 0.57, 95% CI 0.39–0.84, P = 0.004).

Conclusions

BCT did not significantly affect survival outcomes of young patients with breast cancer. Superior survival of BCT compared to mastectomy was observed only in old patients.

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Abbreviations

BCSS:

Breast cancer-specific survival

BCT:

Breast conserving therapy

CI:

Confidence interval

CPM:

Contralateral prophylactic mastectomy

DCIS:

Ductal carcinoma in situ

DDFS:

Distant disease-free survival

DFS:

Disease-free survival

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

LN:

Lymph node

LR:

Local recurrence

LRR:

Local regional recurrence

NAC:

Neoadjuvant chemotherapy

OS:

Overall survival

PR:

Progesterone receptor

PS:

Propensity score

RT:

Radiotherapy

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Acknowledgements

The authors would like to acknowledge the staff in Breast Cancer Center. We also appreciate Yingjian He who worked on statistics.

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Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China

    Lize Wang, Yingjian He, Jinfeng Li, Tianfeng Wang, Yuntao Xie, Zhaoqing Fan & Tao Ouyang

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  1. Lize Wang
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  2. Yingjian He
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  3. Jinfeng Li
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  4. Tianfeng Wang
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  5. Yuntao Xie
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  7. Tao Ouyang
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Contributions

All authors contributed to the study conception and design. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tao Ouyang.

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The authors have no conflict of interest to declare.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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A broad informed consent was obtained from all individual participants included in the study. However, due to the retrospective nature of the study, specified informed consent was waived.

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Wang, L., He, Y., Li, J. et al. Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method. Breast Cancer Res Treat 183, 717–728 (2020). https://doi.org/10.1007/s10549-020-05821-0

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