Breast Cancer Research and Treatment

, Volume 170, Issue 2, pp 381–390 | Cite as

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

  • Kathrin Thöne
  • Anja Rudolph
  • Nadia Obi
  • Jenny Chang-Claude
  • Dieter Flesch-Janys



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.


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).


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).


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.


Early-stage breast cancer Mastectomy Breast-conserving therapy Survival Prognosis 



Breast cancer-specific survival


Breast-conserving therapy


Cardiovascular disease

ER/PR receptor

Estrogen/progesterone receptor


Hazard ratio


International classification of diseases, 10th revision




Overall survival




Randomized clinical trials



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).

Compliance with ethical standards

Conflicts of interest

The authors declare no conflict of interest.

Supplementary material

10549_2018_4754_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 31 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cancer Epidemiology/Clinical Cancer Registry, University Cancer Center Hamburg (UCCH)University Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  3. 3.Department of Medical Biometry and EpidemiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  4. 4.Genetic Tumor Epidemiology GroupUniversity Medical Center Hamburg-EppendorfHamburgGermany

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