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Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies.

Methods

We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method.

Results

From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55–0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49–0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46–0.64).

Conclusions

Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.

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Authors and Affiliations

  1. Department of General Surgery, University of Massachusetts, Worcester, MA, USA

    Gabriel De la Cruz Ku MD

  2. Universidad Científica del Sur, Lima, Peru

    Gabriel De la Cruz Ku MD & Diego Chambergo-Michilot BS

  3. Department of General Surgery, Tufts Medical Center, Boston, MA, USA

    Manish Karamchandani MD & David Posawatz MS

  4. Universidad Nacional Autonoma de Nicaragua, Nicaragua, USA

    Alexis R. Narvaez-Rojas MD

  5. Lahey Hospital and Medical Center, Burlington, MA, USA

    Michael Jonczyk MD

  6. Universidad Peruana de Ciencias Aplicadas, Lima, Peru

    Fortunato S. Príncipe-Meneses BS

  7. Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA

    Salvatore Nardello DO, MBS & Abhishek Chatterjee MD, MBA

  8. Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA

    Abhishek Chatterjee MD, MBA

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  1. Gabriel De la Cruz Ku MD
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Dr. Chatterjee is a consultant for 3M and Royal. None of the remaining authors has any commercial interest in the subject of this study that may be perceived as a potential conflict of interest. No industry or financial/material support was given specifically for this study.

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De la Cruz Ku, G., Karamchandani, M., Chambergo-Michilot, D. et al. Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients. Ann Surg Oncol 29, 6163–6188 (2022). https://doi.org/10.1245/s10434-022-12133-8

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