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Prognostic impact of surgery for early-stage invasive breast cancer on breast cancer-specific survival, overall survival, and recurrence risk: a population-based analysis

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

Abstract

Purpose

Recent cohort studies demonstrated better overall survival (OS) or breast cancer-specific survival (BCS) for breast-conserving therapy (BCT) followed by radiation (RT) compared to mastectomy alone (MT). This is the first observational study in which adjustments for a comprehensive set of prognostic factors, adjuvant therapies, mode of detection, and comorbidities were possible to investigate OS, BCS, as well as recurrence risk of patients undergoing BCT + RT, MT + RT, or MT.

Methods

Women aged 50–74 years at diagnosis of early-stage invasive breast cancer (I–IIIa) between 2001 and 2005 at the German population-based case–control study (MARIE study) were recruited and followed prospectively as a case cohort until 2015. Kaplan–Meier estimates and stepwise adjusted multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI).

Results

The 2762 patients included were followed up for a median of 11.9 years (95% CI 11.8–12.0). 74.2% of patients underwent BCT + RT; 10.3% MT + RT and 15.6% MT alone. Compared to patients treated with MT alone, patients treated with BCT + RT showed non-statistically significant improved OS (HR 0.79, 95% CI 0.61–1.02), BCS (HR 0.79, 95% CI 0.55–1.12), and no difference in recurrence risks (HR 1.01, 95% CI 0.74–1.37). For patients treated with MT + RT, there were no differences in OS (HR 1.06, 95% CI 0.75–1.50), BCS (HR 1.17, 95% CI 0.75–1.82), or recurrence risk (HR 1.33, 95% CI 0.89–1.97).

Conclusions

Among patients with early-stage breast cancer, clinical outcomes more than 10 years after diagnosis did not differ between the primary treatment options BCT + RT, MT + RT versus MT alone after full adjustment.

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Abbreviations

BCS:

Breast cancer-specific survival

BCT:

Breast-conserving therapy

CVD:

Cardiovascular disease

ER/PR receptor:

Estrogen/progesterone receptor

HR:

Hazard ratio

ICD-10-GM:

International classification of diseases, 10th revision

MT:

Mastectomy

OS:

Overall survival

RT:

Radiation

RCT:

Randomized clinical trials

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Acknowledgements

We are grateful to all MARIE study participants. We also thank U. Eilber, S. Behrens, J. Mertin, J. Roczen, and T. Olchers for most valuable technical assistance and data management. The MARIE, MARIEplus, and MARIEplus2 study were funded by the Deutsche Krebshilfe e.V. (#70-2892-BR I, #108253 and #108419, #70110826 and #70112562).

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Authors and Affiliations

  1. Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Kathrin Thöne & Dieter Flesch-Janys

  2. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Martinistr. 52, 20246, Heidelberg, Germany

    Anja Rudolph & Jenny Chang-Claude

  3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Nadia Obi & Dieter Flesch-Janys

  4. Genetic Tumor Epidemiology Group, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jenny Chang-Claude

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  1. Kathrin Thöne
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Correspondence to Kathrin Thöne.

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Thöne, K., Rudolph, A., Obi, N. et al. Prognostic impact of surgery for early-stage invasive breast cancer on breast cancer-specific survival, overall survival, and recurrence risk: a population-based analysis. Breast Cancer Res Treat 170, 381–390 (2018). https://doi.org/10.1007/s10549-018-4754-6

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