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Levickytė J, Skučaitė A, Šiaulys J, Puišys R, Vincerževskienė I. Actuarial Analysis of Survival after Breast Cancer Diagnosis among Lithuanian Females. Healthcare (Basel) 2024; 12:746. [PMID: 38610168 PMCID: PMC11012188 DOI: 10.3390/healthcare12070746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer is the most common cause of mortality due to cancer for women both in Lithuania and worldwide. The chances of survival after diagnosis differ significantly depending on the stage of disease at the time of diagnosis and other factors. One way to estimate survival is to construct a Kaplan-Meier estimate for each factor value separately. However, in cases when it is impossible to observe a large number of patients (for example, in the case of countries with lower numbers of inhabitants), dividing the data into subsets, say, by stage at diagnosis, may lead to results where some subsets contain too few data, thus causing the results of a Kaplan-Meier (or any other) method to become statistically incredible. The problem may become even more acute if researchers want to use more risk factors, such as stage at diagnosis, sex, place of living, treatment method, etc. Alternatively, Cox models can be used to analyse survival data with covariates, and they do not require the data to be divided into subsets according to chosen risks factors (hazards). We estimate the chances of survival for up to 5 years after a breast cancer diagnosis for Lithuanian females during the period of 1995-2016. Firstly, we construct Kaplan-Meier estimates for each stage separately; then, we apply a (stratified) Cox model using stage, circumstance of diagnosis, and year of diagnosis as (potential) hazards. Some directions of further research are provided in the last section of the paper.
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Affiliation(s)
- Justina Levickytė
- Institute of Mathematics, Vilnius University, Naugarduko 24, LT-03225 Vilnius, Lithuania; (J.L.); (A.S.); (R.P.)
| | - Aldona Skučaitė
- Institute of Mathematics, Vilnius University, Naugarduko 24, LT-03225 Vilnius, Lithuania; (J.L.); (A.S.); (R.P.)
| | - Jonas Šiaulys
- Institute of Mathematics, Vilnius University, Naugarduko 24, LT-03225 Vilnius, Lithuania; (J.L.); (A.S.); (R.P.)
| | - Rokas Puišys
- Institute of Mathematics, Vilnius University, Naugarduko 24, LT-03225 Vilnius, Lithuania; (J.L.); (A.S.); (R.P.)
| | - Ieva Vincerževskienė
- Laboratory of Clinical Oncology, National Cancer Institute, Santariškių 1, LT-08660 Vilnius, Lithuania;
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Ho PJ, Lim EH, Mohamed Ri NKB, Hartman M, Wong FY, Li J. Will Absolute Risk Estimation for Time to Next Screen Work for an Asian Mammography Screening Population? Cancers (Basel) 2023; 15:cancers15092559. [PMID: 37174025 PMCID: PMC10177032 DOI: 10.3390/cancers15092559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and 15-year) absolute risks in 28,234 asymptomatic Asian women. Absolute risks were calculated using different relative risk estimates and Breast cancer incidence and mortality rates (White, Asian-American, or the Singapore Asian population). Using linear models, we tested the association of absolute risk and age at breast cancer occurrence. Model discrimination was moderate (AUC range: 0.580-0.628). Calibration was better for longer-term prediction horizons (E/Olong-term ranges: 0.86-1.71; E/Oshort-term ranges:1.24-3.36). Subgroup analyses show that the model underestimates risk in women with breast cancer family history, positive recall status, and prior breast biopsy, and overestimates risk in underweight women. The Gail model absolute risk does not predict the age of breast cancer occurrence. Breast cancer risk prediction tools performed better with population-specific parameters. Two-year absolute risk estimation is attractive for breast cancer screening programs, but the models tested are not suitable for identifying Asian women at increased risk within this short interval.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore 138672, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
| | - Nur Khaliesah Binte Mohamed Ri
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 119228, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore 138672, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
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Sayed MM, Mohamed DO, Hassan MSF, Elshoieby MH, Elnaggar MS, Khallaf LM, Sedik MF, Khallaf SM. Is Survival with Conservative Breast Therapy Becoming Superior to That with Modified Radical Mastectomy Alone for the Treatment of Early Breast Cancer in This Era? Indian J Surg Oncol 2023; 14:243-248. [PMID: 36891412 PMCID: PMC9986136 DOI: 10.1007/s13193-020-01188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 08/19/2020] [Indexed: 11/30/2022] Open
Abstract
This study aims to assess survival rates in early breast cancer patients treated by conservative breast therapy (CBT), including radiotherapy, compared with those treated by modified radical mastectomy (MRM) alone. The South Egypt Cancer Institute and the Assiut University Oncology Department patients' records, from January 2010 to December 2017, were searched for T1-2N0-1M0 breast cancer patients treated by CBT or MRM. Patients who did not receive chemotherapy were excluded to reduce the treatment variation. The 5-year locoregional disease-free survival (LRDFS) was 97.3% for the CBT patients was and 98.0% for the MRM patients (P = .675). The 5-year distant disease-free survival (DDFS) was 93.6% for CBS and 85.7% for MRM (P = 0.033). The DFS was 91.9% for the BCT patients and 85.3% for the MRM patients (P = 0.045). The 5-year OS was 98.2% for the CBT patients and 94.3% for the MRM patients, (P = 0.02). By Cox regression analysis, the CBT resulted in significantly better OS, (P = 0.018) and the HR = 0.350, 95% CI 0.146-0.837. The adjusted OS, estimated by the propensity score-based weights, remained superior in CBT than in MRM patients (P < 0.001). CBT resulted in better DDFS, DFS, and OS than MRM. Future randomized trials are needed to confirm these findings and determine the cause.
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Affiliation(s)
- Mona M. Sayed
- Radiation Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Dalia O. Mohamed
- Radiation Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Marwa S. F. Hassan
- Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Mahmoud H. Elshoieby
- Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | | - Lamia M. Khallaf
- Radiodiagnosis Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Mayada F. Sedik
- Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Salah M. Khallaf
- Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Ke S, Wang W, Li B, Feng X, Yan D, Liu J. Superior survival for breast-conserving therapy over mastectomy in patients with breast cancer: A population-based SEER database analysis across 30 years. Front Oncol 2023; 12:1032063. [PMID: 36686746 PMCID: PMC9846313 DOI: 10.3389/fonc.2022.1032063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction It has been believed that breast-conserving therapy (lumpectomy plus adjuvant radiation, Lum + RT) and mastectomy without radiation (Mast + NoRT) have equivalent survival outcomes. However, there is a need to re-evaluate the role of lumpectomy plus adjuvant radiation due to changed breast cancer management over time. This study aimed to conduct a population-based study that compare long-term oncologic survival outcomes after Lum + RT vs Mast + NoRT. Methods The Surveillance, Epidemiology and End Results database was used to identify female breast cancer patients with a primary localized breast cancer diagnosis from 1988 to 2018. The standardized incidence/mortality ratio (SIR/SMR) for breast cancer recurrence (BCR) and breast cancer-specific death (BSD) was estimated by the SEER*Stat program. Cumulative incidences of BCR and BSD were assessed using Gray's method. We evaluated the effects of Lum + RT vs. Mast + NoRT on breast cancer recurrence-free survival (BRFS) and breast cancer-specific survival (BCSS). Fine-Gray competing risk model analyses, propensity score-adjusted Kaplan-Meier analyses and Cox proportional hazards model analyses were applied. Results A total of 205,788 women were included in the study. Patients who underwent Lum + RT had higher SIR of BCR (4.14 [95% confidence interval, CI: 3.94-4.34] vs. 1.11 [95% CI: 1.07-1.14]) and lower SMR (9.89 [95% CI: 9.71-10.08] vs. 17.07 [95% CI: 16.82-17.33]) than patients who underwent Mast + NoRT. Lum + RT was associated with higher competing risk of BCR (adjusted hazard ratio [HR]: 1.996, 95% CI: 1.925-2.069, p < 0.001) and lower competing risk of BSD when compared to Mast + RT (adjusted HR: 0.584, 95% CI: 0.572-0.597, p < 0.001). Multivariate Cox regression analysis revealed similar results (adjusted HR after PSW for BRFS: 1.792, 95% CI 1.716-1.871, p < 0.001; adjusted HR after PSW for BCSS: 0.706, 95% CI 0.688-0.725, p < 0.001). These findings persisted in the sensitivity and subgroup analyses. Discussion The present study further confirmed superior long-term survival with lumpectomy plus adjuvant radiation over mastectomy independent of patient characteristics including age, race, time period, historic subtype, tumor size, historic grade and stage, indicating that this benefit may result from the treatment itself.
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Affiliation(s)
- Shanbao Ke
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Wei Wang
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Baiyu Li
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiao Feng
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Danfang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianbo Liu
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China,*Correspondence: Jianbo Liu,
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Gwark S, Kim HJ, Kim J, Chung IY, Kim HJ, Ko BS, Lee JW, Son BH, Ahn SH, Lee SB. Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Ann Surg Oncol 2022; 30:2845-2853. [PMID: 36577865 DOI: 10.1245/s10434-022-12993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Breast-conserving surgery (BCS) plus radiotherapy (BCS + RT) has been shown to improve survival compared with mastectomy in patients with early breast cancer; however, whether this superiority is maintained in breast cancer patients receiving neoadjuvant chemotherapy (NCT) is unclear. We evaluated and compared the survival outcomes after BCS + RT and mastectomy in Korean women with breast cancer treated with NCT. METHODS We evaluated 1641 patients who received NCT before surgery (BCS or mastectomy). We performed propensity score matching to minimize potential bias due to factors other than the surgical method and compared the 5-year, disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates before and after exact matching. RESULTS Among the 1641 patients, 839 (51.1%) underwent BCS + RT and 802 (48.9%) underwent mastectomy. Patients who underwent mastectomy had larger tumors and more frequently had positive nodes. For BCS+RT and mastectomy, the unadjusted 5-year DFS, 5-year DMFS, and 5-year OS rates were 87.0% and 73.1%, 89.5% and 77.0%, and 91.8% and 81.0%, respectively (all p < 0.05 = 0.000). After PSM, 5-year DFS, 5-year DMFS, and 5-year OS rates for BCS + RT and mastectomy were 87.6% and 69.1%, 89.7% and 76.0%, and 89.1% and 75.7%, respectively (all p < 0.05). In both unadjusted and adjusted analyses accounting for various confounding factors, BCS + RT was significantly associated with improved DFS (p < 0.05), DMFS (p < 0.05), and OS (p < 0.05) rates compared with mastectomy. CONCLUSIONS BCS + RT does not impair DFS and OS in patients treated with NCT. Tumor biology and treatment response are significant prognostic indicators. Our results suggest that BCS + RT may be preferred in most breast cancer patients when both BCS and mastectomy are suitable.
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Affiliation(s)
- Sungchan Gwark
- Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hwa Jung Kim
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Hyun Ahn
- Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Christiansen P, Mele M, Bodilsen A, Rocco N, Zachariae R. Breast-Conserving Surgery or Mastectomy?: Impact on Survival. ANNALS OF SURGERY OPEN 2022; 3:e205. [PMID: 37600290 PMCID: PMC10406082 DOI: 10.1097/as9.0000000000000205] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 01/05/2023] Open
Abstract
The early randomized controlled trials revealed no differences in survival between breast-conserving surgery (BCS) and mastectomy. However, breast cancer treatment has undergone changes, and the results of recent population-based registry studies suggest superior long-term survival after BCS. To explore the current evidence, a systematic review and meta-ana lysis of population-based observational studies from 2010 and onward was conducted. Methods A literature search was conducted in the PubMed, Embase, and Cochrane databases to identify relevant literature. Keywords included "mastectomy," "breast conserving surgery," and "survival." The identified studies were narratively reviewed and effect sizes (hazard ratios [HRs]) for overall (OS) and breast cancer-specific survival (BCSS) were combined with random-effects models. Results A total of 30 reports were included in the review, and results from 25 studies were included in the meta-analyses. Compared with mastectomy, BCS was associated with better OS (HR = 1.34 [1.20-1.51]; N = 1,311,600) and BCSS (HR = 1.38 [1.29-1.47]; N = 494,267). Selected subgroups of patients, based on lymph node status, age (<50 years/≥50 years), and radiation therapy after mastectomy (±), all showed better overall survival after BCS. The number (range 4-12) and type of prognostic variables adjusted for in the survival analyses of the studies did not statistically significantly moderate the differences in survival between BCS and mastectomy. Conclusions The combined findings from large population-based studies indicate that BCS is associated with survival benefit compared with mastectomy, suggesting that BCS be the recommended treatment of early breast cancer (T1-2N0-1M0) if a radical lumpectomy can be performed.
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Affiliation(s)
- Peer Christiansen
- From the Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Marco Mele
- Department of Breast Surgery, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Anne Bodilsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Rocco
- Department of Breast Surgery, University Hospital Federico II, Naples, Italy
| | - Robert Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Kerin EP, Davey MG, McLaughlin RP, Sweeney KJ, Barry MK, Malone CM, Elwahab SA, Lowery AJ, Kerin MJ. Comparison of the Nottingham Prognostic Index and OncotypeDX© recurrence score in predicting outcome in estrogen receptor positive breast cancer. Breast 2022; 66:227-235. [PMID: 36335747 PMCID: PMC9647009 DOI: 10.1016/j.breast.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Traditionally, Nottingham prognostic index (NPI) informed prognosis in patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative, node negative (ER+/HER2-/LN-) breast cancer. At present, OncotypeDX© Recurrence Score (RS) predicts prognosis and response to adjuvant chemotherapy (AC). AIMS To compare NPI and RS for estimating prognosis in ER + breast cancer. METHODS Consecutive patients with ER+/HER2-/LN- disease were included. Disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier and Cox regression analyses. RESULTS 1471 patients met inclusion criteria. The mean follow-up was 110.7months. NPI was calculable for 1382 patients: 19.8% had NPI≤2.4 (291/1471), 33.0% had NPI 2.41-3.4 (486/1471), 30.0% had NPI 3.41-4.4 (441/1471), 10.9% had NPI 4.41-5.4 (160/1471), and 0.3% had NPI>5.4 (4/1471). In total, 329 patients underwent RS (mean RS: 18.7) and 82.1% had RS < 25 (270/329) and 17.9% had RS ≥ 25 (59/329). Using multivariable Cox regression analyses (n = 1382), NPI independently predicted DFS (Hazard ratio (HR): 1.357, 95% confidence interval (CI): 1.140-1.616, P < 0.001) and OS (HR: 1.003, 95% CI: 1.001-1.006, P = 0.024). When performing a focused analysis of those who underwent both NPI and RS (n = 329), neither biomarker predicted DFS or OS. Using Kaplan Meier analyses, NPI category predicted DFS (P = 0.008) and (P = 0.026) OS. Conversely, 21-gene RS group failed to predict DFS (P = 0.187) and OS (P = 0.296). CONCLUSION In our focused analysis, neither NPI nor RS predicted survival outcomes. However, in the entire series, NPI independently predicted both DFS and OS. On the 40th anniversary since its derivation, NPI continues to provide accurate prognostication in breast cancer, outperforming RS in the current study.
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Affiliation(s)
- Eoin P. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Matthew G. Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Corresponding author. Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.
| | | | - Karl J. Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K. Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M. Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J. Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
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Guo Y, Wan Q, Ouyang T, Li J, Wang T, Fan Z, Xie Y. Risk of ipsilateral breast tumor recurrence and contralateral breast cancer in patients with and without TP53 variant in a large series of breast cancer patients. Breast 2022; 65:55-60. [PMID: 35820297 PMCID: PMC9284452 DOI: 10.1016/j.breast.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The association between breast cancer patients with a TP53 pathogenic variant and risk of local recurrence and contralateral breast cancer remains largely unknown. Methods The study population of 11093 patients was derived from two cohorts at the Breast Center of Peking University Cancer Hospital in China from November 2003, to March 2018. TP53 germline variants were determined for all patients. Results In the study, forty-one (0.37%) carried a TP53 germline pathogenic variant, and 11052 were non-carriers (99.63%). Nineteen TP53 carriers (46.3%) and 4173 non-carriers (37.8%) were treated with breast-conserving therapy (BCT), while the remaining were treated with mastectomy. After a median follow-up of 6.7 years, the rate of ipsilateral breast tumor recurrence (IBTR) in TP53 carriers was significantly higher than that in non-carriers when treated with BCT (21.1% vs 3.8%, P = 0.006). No difference in the rate of IBTR was found between TP53 carriers and non-carriers when treated with mastectomy (0.0% vs 2.6%, P = 1.0). Furthermore, the rate of IBTR in TP53 carriers treated with BCT was significantly higher than that in those treated with mastectomy (21.1% vs 0.0%, P = 0.038). The 10-year cumulative risk of contralateral breast cancer in TP53 carriers was significantly higher than that in non-carriers (17.9% vs 3.6%, hazard ratio (HR) = 7.0, 95% CI: 3.3–14.9, P < 0.001). Conclusions Patients with TP53 variants have a high risk of IBTR when treated with BCT, and exhibit a very high risk of contralateral breast cancer. TP53 carriers may not be suitable for BCT and prophylactic contralateral mastectomy might be considered. Patients with a TP53 variant have a high risk of IBTR when treated with BCT. TP53 carriers exhibit a very high risk of contralateral breast cancer. TP53 carriers may not be suitable for BCT. Prophylactic contralateral mastectomy may be considered for TP53 carriers.
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Xiang W, Wu C, Wu H, Fang S, Liu N, Yu H. Survival Comparisons between Breast Conservation Surgery and Mastectomy Followed by Postoperative Radiotherapy in Stage I-III Breast Cancer Patients: Analysis of the Surveillance, Epidemiology, and End Results (Seer) Program Database. Curr Oncol 2022; 29:5731-5747. [PMID: 36005190 PMCID: PMC9406949 DOI: 10.3390/curroncol29080452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aims to evaluate the overall and breast cancer-specific survival (BCSS) after breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy plus RT in resectable breast cancer. Moreover, the aim is to also identify the subgroups who benefit from BCS plus RT and establish a predictive nomogram for stage II patients. Methods: Stage I−III breast cancer patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1990 and 2016. Patients with available clinical information were split into two groups: BCS plus RT and mastectomy plus RT. Kaplan−Meier survival analysis, univariate and multivariate regression analysis, and propensity score matching were used in the study. Hazard ratio (HR) was calculated based on stratified Cox univariate regression analyses. A prognostic nomogram by multivariable Cox regression model was developed for stage II patients, and consistency index (C-index) and calibration curve were used to evaluate the accuracy of the nomogram in the training and validation set. Results: A total of 24,590 eligible patients were enrolled. The difference in overall survival (OS) and BCSS remained significant in stage II patients both before and after PSM (after PSM: OS: HR = 0.8536, p = 0.0115; BCSS: HR = 0.7803, p = 0.0013). In stage II patients, the survival advantage effect of BCS plus RT on OS and BCSS was observed in the following subgroups: any age, smaller tumor size (<1 cm), stage IIA (T2N0, T0−1N1), ER (+), and any PR status. Secondly, the C-indexes for BCSS prediction was 0.714 (95% CI 0.694−0.734). The calibration curves showed perfect agreement in both the training and validation sets. Conclusions: BCS plus RT significantly improved the survival rates for patients of stage IIA (T2N0, T0−1N1), ER (+). For stage II patients, the nomogram was a good predictor of 5-, 10-, and 15-year BCSS. Our study may help guide treatment decisions and prolong the survival of stage II breast cancer patients.
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Affiliation(s)
- Wenbin Xiang
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China
| | - Chaoyan Wu
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huachao Wu
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China
| | - Sha Fang
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China
| | - Nuomin Liu
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China
| | - Haijun Yu
- Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China
- Correspondence: ; Tel.: +86-027-6781-3154
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Wang S, Zhang Y, Yin F, Wang X, Yang Z. Survival Outcomes After Breast-Conserving Therapy Compared With Mastectomy for Patients With Early-Stage Invasive Micropapillary Carcinoma of the Breast: A SEER Population-Based Study. Front Oncol 2021; 11:741737. [PMID: 34790571 PMCID: PMC8591165 DOI: 10.3389/fonc.2021.741737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022] Open
Abstract
Background Invasive micropapillary breast carcinoma (IMPC) is a relatively rare pathological type of invasive breast cancer. Little is currently known on the efficacy and safety of breast-conserving treatment (BCT, lumpectomy plus postsurgical radiation) compared with mastectomy in women diagnosed with early-stage IMPC. Accordingly, we sought to investigate the long-term prognostic differences between BCT and mastectomy in patients with T1-3N0-3M0 invasive micropapillary breast carcinoma using data from the Surveillance, Epidemiology, and End Results (SEER) database. Materials and Methods We retrospectively analyzed 1,203 female patients diagnosed with early-stage IMPC between 2004 and 2015 from the SEER database. The impact of different surgical approaches on patient prognosis was assessed by the Kaplan-Meier method and Cox proportional risk models. Results A total of 609 and 594 patients underwent mastectomy and BCT, respectively. Compared with patients who underwent a mastectomy, patients in the BCT group were older and had lower tumor diameters, lower rates of lymph nodes metastasis, and higher rates of ER receptor positivity and PR receptor positivity (p < 0.05). Kaplan-Meier plots showed that the overall survival (OS) and breast cancer-specific survival (BCSS) were higher in the BCT group than in the mastectomy group. In subgroup analysis, patients with T2 stage in the BCT group had better OS than the mastectomy group. Multivariate analysis showed no statistical difference in OS and BCSS for patients in the mastectomy group compared with the BCT group (hazard ratio (HR) = 0.727; 95% confidence interval (95% CI) 0.369–1.432, p = 0.357; HR = 0.762; 95% CI 0.302–1.923, p = 0.565; respectively). During the multivariate analysis and stratifying for the T stage, a better OS was found for patients with T2 stage in the BCT group than the mastectomy group (HR = 0.333, 95% CI: 0.149–0.741, p = 0.007). There was no significant difference in OS for patients with T1 and T3 stages between the BCT and mastectomy groups (p > 0.05). Conclusion In women with early-stage IMPC, BCT was at least equivalent to mastectomy in terms of survival outcomes. When both procedures are feasible, BCT should be recommended as the standard surgical treatment, especially for patients with T2 disease.
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Affiliation(s)
- Song Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Yiyuan Zhang
- Department of Reproductive Endocrinology, Affiliated Reproductive Hospital of Shandong University, Jinan, China
| | - Fangxu Yin
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Xiaohong Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Zhenlin Yang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, China
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11
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Stahl KA, Dodge D, Olecki EJ, Holguin RP, McLaughlin C, Wong W, Shen C. Insurance Status and Travel Distance to Single Treatment Facility Predictive of Mastectomy. J Surg Res 2021; 270:22-30. [PMID: 34628160 DOI: 10.1016/j.jss.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We evaluated the impact of insurance status and travel distance on the receipt of total mastectomy without reconstruction (TM) compared to breast conserving surgery with radiation (BCT) for early-stage breast cancer (BC) patients who received care at a single facility. We hypothesized that, lack of insurance and increased travel distance would be predictive of TM over BCT and disparities would vary by different races and/or ethnicities. METHODS Using the National Cancer Database from 2010-2017, we examined surgical patients with stage I or II BC, who received care at one facility. Chi-square tests examined subgroup differences by BCT or TM. Multivariable logistic regressions evaluated patient, facility, and pathologic factors associated with the receipt of TM over BCT for the entire cohort and by races and/or ethnicities. RESULTS Of the 284,202 patients, 70.1% received BCT while 29.9% received TM. After adjustment travel distance > 60 miles to a treatment facility, and non-insured patients were more likely to receive TM over BCT, when compared to travel distance < 20 miles and private insurance (all P < 0.05). Compared to other races and/or ethnicities, African Americans traveling > 60 miles were 65.4% more likely to receive TM over BCT compared to those traveling < 20 miles (P < .0001). Across all races and/or ethnicities after adjustment, lack of insurance was predictive for receipt of TM over BCT (P < 0.05). CONCLUSIONS Despite treatment at one facility, increased travel distance and insurance status are independently predictive of the receipt of TM over BCT in patients with early-stage BC. While travel distance is particularly impactful for African Americans, the impact of not having insurance on surgical treatments is universal across all races and/or ethnicities.
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Affiliation(s)
- Kelly A Stahl
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Daleela Dodge
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Elizabeth J Olecki
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Rolfy Perez Holguin
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Christopher McLaughlin
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - William Wong
- College of Medicine, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | - Chan Shen
- College of Medicine, Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, Hershey, Pennsylvania.
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12
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Gonzalez V, Arver B, Löfgren L, Bergkvist L, Sandelin K, Eriksson S. Impact of preoperative breast MRI on 10-year survival of patients included in the Swedish randomized multicentre POMB trial. BJS Open 2021; 5:6382013. [PMID: 34611701 PMCID: PMC8493003 DOI: 10.1093/bjsopen/zrab088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Background The value of preoperative breast MRI as an adjunct technique regarding its effect on re-excision rates has been a subject of discussion. No survival data regarding preoperative breast MRI are available from randomized studies. Methods Ten-year follow-up of the POMB randomized multicentre study was analysed, evaluating MRI and its effect on disease-free survival (DFS) and overall survival (OS). Patients with newly diagnosed breast cancer were randomized to either preoperative MRI or conventional imaging. Kaplan–Meier plots were used to analyse DFS and OS, and Cox regression to estimate hazard ratios (HRs). Results A total of 440 patients, aged 56 years or less, with newly diagnosed breast cancer were randomized to either preoperative MRI (220) or conventional imaging (220; control). Median follow-up for each group was 10 years. DFS rates were 85.5 and 80.0 per cent for the MRI and control groups respectively (P = 0.099). The risk of relapse or death was 46 per cent higher in the control group (HR 1.46, 95 per cent c.i. 0.93 to 2.29). OS rates after 10 years were 90.9 and 88.6 per cent in the MRI and control groups respectively (P = 0.427). The risk of death was 27 per cent higher in the control group (HR 1.27, 0.71 to 2.29). Locoregional, distant, and contralateral recurrence outcomes combined were increased in the control group (P = 0.048). A subgroup analysis of patients with breast cancer stages I–III showed that preoperative MRI improved DFS compared with conventional imaging, but this did not reach statistical significance (P = 0.057). Conclusion After 10 years of follow-up, preoperative breast MRI as an adjunct to conventional imaging resulted in slightly, but non-significantly, improved DFS and OS. Registration number: NCT01859936 (http://www.clinicaltrials.gov).
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Affiliation(s)
- V Gonzalez
- Region Vastmanland-Uppsala University, Centre for Clinical Research, Hospital of Vastmanland Vasteras, Vasteras, Sweden
| | - B Arver
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - L Löfgren
- Department of Surgery, St Goran Hospital, Stockholm, Sweden
| | - L Bergkvist
- Region Vastmanland-Uppsala University, Centre for Clinical Research, Hospital of Vastmanland Vasteras, Vasteras, Sweden
| | - K Sandelin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - S Eriksson
- Region Vastmanland-Uppsala University, Centre for Clinical Research, Hospital of Vastmanland Vasteras, Vasteras, Sweden.,Department of Surgery, Hospital of Vastmanland Vasteras, Vasteras, Sweden
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13
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Keelan S, Flanagan M, Hill ADK. Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers. Front Oncol 2021; 11:622621. [PMID: 34422626 PMCID: PMC8371403 DOI: 10.3389/fonc.2021.622621] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/19/2021] [Indexed: 01/12/2023] Open
Abstract
The management of breast cancer has evolved into a multidisciplinary evidence-based surgical speciality, with emphasis on conservative surgery. A number of landmark trials have established lumpectomy followed by radiation as the standard of care for many patients. The aim of this study is to construct a narrative review of recent developments in the surgical management of breast cancer and how such developments have impacted surgical practice. A comprehensive literature search of Pubmed was conducted. The latest search was performed on October 31st, 2020. Search terms “breast cancer” were used in combinations with specific key words and Boolean operators relating to surgical management. The reference lists of retrieved articles were comprehensively screened for additional eligible publications. Articles were selected and reviewed based on relevance. We selected publications in the past 10 years but did not exclude commonly referenced and highly regarded previous publications. Review articles and book chapters were also cited to provide reference on details not discussed in the academic literature. This article reviews the current evidence in surgical management of early-stage breast cancer, discusses recent trends in surgical practice for therapeutic and prophylactic procedures and provides commentary on implications and factors associated with these trends.
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Affiliation(s)
- Stephen Keelan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Michael Flanagan
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- The Department of Surgery, The Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of Surgery, Beaumont Hospital, Dublin, Ireland
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14
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Zhang J, Yang C, Lei C, Zhang Y, Ji F, Gao H, Yang M, Zhang L, Li J, Zhu T, Li W, Zhuang X, Wang K. Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2412 patients. Breast 2021; 58:10-17. [PMID: 33878598 PMCID: PMC8080072 DOI: 10.1016/j.breast.2021.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous studies revealed that patients with early-stage metaplastic breast cancer (MBC) underwent mastectomy more often than breast-conserving therapy (BCT) mainly due to the larger tumor size. This study was performed to compare the survival outcomes following BCT versus mastectomy for patients with early-stage MBC. METHODS Surveillance, Epidemiology, and End Results (SEER) database was used to identify women diagnosed with early-stage MBC (T1-3N0-3M0) between 2001 and 2016, who were treated with either BCT or mastectomy. We assessed overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan-Meier method and hazard ratios using Cox proportional hazards models. RESULTS A total of 2412 MBC patients were identified, 881 (36.5%) of whom underwent BCT and 1531(63.5%) underwent mastectomy. The median follow-up time was 73 months. Most of patients had older age (≥50 years old), larger tumor size, higher American Joint Committee on Cancer (AJCC) stage and hormone receptor negativity. After adjustment for confounding variables, patients who underwent BCT had significantly improved OS (5-year OS: 84.3% vs 62.5%; 10-year OS: 73.0% vs 52.1%; adjusted HR = 0.76, 95%CI: 0.59-0.97, p = 0.028) and BCSS (5-year BCSS: 89.1% vs 70.8%; 10-year BCSS: 83.9% vs 67.5%; adjusted HR = 0.72, 95%CI: 0.53-0.96, p = 0.026) than those who underwent mastectomy, and this improvement remained significant for all T and N stages of MBC except for N2-3 stage. CONCLUSION BCT conferred improved OS and BCSS compared with mastectomy for patients with early-stage MBC, and the improvement persisted in almost all of the subgroups of different T and N stages.
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Affiliation(s)
- Junsheng Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Shantou University Medical College, Shantou, 515041, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Chuqian Lei
- Department of Breast Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, China
| | - Yi Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jieqing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Weiping Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xiaosheng Zhuang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Shantou University Medical College, Shantou, 515041, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Shantou University Medical College, Shantou, 515041, China.
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15
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Murphy J, Gandhi A. Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer? Clin Oncol (R Coll Radiol) 2021; 33:440-447. [DOI: 10.1016/j.clon.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 01/12/2023]
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16
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Pan C, Sun G, Sha M, Wang P, Gu Y, Ni Q. Investigation of miR-93-5p and its effect on the radiosensitivity of breast cancer. Cell Cycle 2021; 20:1173-1180. [PMID: 34024254 PMCID: PMC8265785 DOI: 10.1080/15384101.2021.1930356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Accumulating evidence suggests that intrinsic resistance to radiotherapy reduces the survival of patients with cancer. The present study investigated whether miR-93-5p affects proliferation, migration, apoptosis, and radiosensitivity of breast cancer (BC) cells. MDA-MB-468, MCF-7, and MDA-MB-231 BC cells were incubated with hsa-miR-93-5p mimics, hsa-miR-93-5p inhibitor, and negative control RNA with or without exposure to ionizing radiation to determine cell proliferation, migration, and apoptosis using the Cell Counting Kit-8 assay, wound healing assay and apoptotic assay, respectively. Overexpression of miR-93-5p inhibited the migratory abilities (P = 0.001) and decreased the cell proliferation (P = 0.049) of MCF-7 cells. In MCF-7 cells, a significant increase in apoptosis was detected after treatment with miR-93-5p compared with the negative control (P = 0.001) and miR-93-5p inhibitor (P = 0.004). In MDA-MB-468 cells, the proportion of apoptotic cells increased following exposure to ionizing radiation (P = 0.001). The percentage of apoptotic MDA-MB-231 cells in the miR-93-5p group was significantly increase compared with that determined in the negative control (P = 0.044) and hsa-miR-93-5p inhibitor (P = 0.046) groups. In conclusion, our findings showed that miR-93-5p reduces BC cell proliferation and migratory capacity, and increases the ratio of apoptotic cells. Overexpression of miR-93-5p could increase radiosensitivity in BC cells by increasing apoptosis. This evidence provides new insight into the treatment of BC and identifies miR-93-5p as a potential therapeutic target.
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Affiliation(s)
- Chi Pan
- Department of General Surgery, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Guangzhi Sun
- Department of Oncology, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Min Sha
- Department of Central Laboratory, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Peng Wang
- Department of Oncology, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Yawen Gu
- Department of Oncology, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
| | - Qingtao Ni
- Department of Oncology, Hospital Affiliated 5 to Nantong University (Taizhou People's Hospital), Taizhou, China
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17
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Actuarial Analysis of Survival among Breast Cancer Patients in Lithuania. Healthcare (Basel) 2021; 9:healthcare9040383. [PMID: 33915700 PMCID: PMC8066802 DOI: 10.3390/healthcare9040383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common cause of mortality due to cancer for women both in Lithuania and worldwide. Chances of survival after diagnosis differ significantly depending on the stage of disease at the time of diagnosis. Extended term periods are required to estimate survival of, e.g., 15–20 years. Moreover, since mortality of the average population changes with time, estimates of survival of cancer patients derived after a long period of observation can become outdated and can be no longer used to estimate survival of patients who were diagnosed later. Therefore, it can be useful to construct analytic functions that describe survival probabilities. Shorter periods of observation can be enough for such construction. We used the data collected by the Lithuanian Cancer Registry for our analysis. We estimated the chances of survival for up to 5 years after patients were diagnosed with breast cancer in Lithuania. Then we found analytic survival functions which best fit the observed data. At the end of this paper, we provided some examples for applications and directions for further research. We used mainly the Kaplan–Meier method for our study.
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18
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Wan Q, Su L, Ouyang T, Li J, Wang T, Fan Z, Fan T, Lin B, Xie Y. Comparison of Survival After Breast-Conserving Therapy vs Mastectomy Among Patients With or Without the BRCA1/2 Variant in a Large Series of Unselected Chinese Patients With Breast Cancer. JAMA Netw Open 2021; 4:e216259. [PMID: 33890992 PMCID: PMC8065382 DOI: 10.1001/jamanetworkopen.2021.6259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Whether patients with breast cancer who carry a BRCA1/2 variant can safely undergo breast-conserving therapy (BCT) remains controversial. OBJECTIVE To compare survival rates after BCT vs mastectomy in BRCA1/2 variant carriers and noncarriers in a large series of unselected patients with breast cancer. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, a large consecutive series of 8396 unselected patients with primary breast cancer underwent either BCT, mastectomy with radiotherapy, or mastectomy alone from October 1, 2003, to May 31, 2015, at the Breast Center of Peking University Cancer Hospital in China. All patients were assessed for BRCA1/2 germline variant status. Statistical analysis was performed from May 1 to September 30, 2020. MAIN OUTCOMES AND MEASURES The primary outcomes were breast cancer-specific survival (BCSS) and overall survival (OS); secondary outcomes included recurrence-free survival, distant recurrence-free survival, and ipsilateral breast tumor recurrence. RESULTS Of these 8396 Chinese patients (8378 women [99.8% women]; mean [SD] age, 50.8 [11.4] years; 187 BRCA1 carriers, 304 BRCA2 carriers, and 7905 noncarriers), 3135 (37.3%) received BCT, 1511 (18.0%) received mastectomy with radiotherapy, and 3750 (44.7%) received mastectomy alone. After a median follow-up of 7.5 years (range, 0.3-16.6 years), both BRCA1 and BRCA2 variant carriers treated with BCT had similar rates of survival compared with those treated with mastectomy with radiotherapy (BCSS: hazard ratio [HR] for BRCA1, 0.58 [95% CI, 0.16-2.10]; P = .41; HR for BRCA2, 0.46 [95% CI, 0.15-1.41]; P = .17; OS: HR for BRCA1, 0.61 [95% CI, 0.18-2.12]; P = .44; HR for BRCA2, 0.72 [95% CI, 0.26-1.96]; P = .52) or mastectomy alone (BCSS: HR for BRCA1, 0.70 [95% CI, 0.22-2.20]; P = .54; HR for BRCA2, 0.59 [95% CI, 0.18-1.93]; P = .39; OS: HR for BRCA1, 0.77 [95% CI, 0.27-2.21]; P = .63; HR for BRCA2, 0.62 [95% CI, 0.22-1.73]; P = .37) after adjusting for clinicopathologic factors and adjuvant therapy. For noncarriers, patients receiving BCT had significantly better survival than those receiving mastectomy with radiotherapy (BCSS: HR, 0.45 [95% CI, 0.36-0.57]; P < .001; OS: HR, 0.46 [95% CI, 0.37-0.58]; P < .001) or mastectomy alone (BCSS: HR, 0.71 [95% CI, 0.57-0.89]; P = .003; OS: HR, 0.71 [95% CI, 0.58-0.87]; P < .001) in multivariable analyses. CONCLUSIONS AND RELEVANCE This study suggests that BRCA1/2 variant carriers treated with BCT have survival rates at least comparable to those treated with mastectomy with radiotherapy or mastectomy alone and that BCT could be an option for BRCA1/2 variant carriers when the tumor is clinically appropriate for BCT.
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Affiliation(s)
- Qiting Wan
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Liming Su
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Tao Ouyang
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jinfeng Li
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Tianfeng Wang
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhaoqing Fan
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Tie Fan
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Benyao Lin
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuntao Xie
- Breast Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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19
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Yang Q, Zhong X, Zhang W, Luo T, He P, Zheng H. Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China. BMC Cancer 2021; 21:107. [PMID: 33530955 PMCID: PMC7856742 DOI: 10.1186/s12885-021-07840-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients’ quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. The surgical approaches are including mastectomy (MAST), breast-conserving therapy (BCT), and mastectomy with reconstruction (MAST+RECON). Methods Based on demographic data, disease-related information and other treatments, we applied propensity score matching (PSM) to perform 1: 1 matching among patients who underwent these three types of surgery in the tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Results After PSM, there were 205 cases in each group. In the matched data set, the distribution of covariates was fully balanced. The total cost of MAST, MAST+RECON and BCT was $37,392.84, $70,556.03 and $82,330.97, respectively. The quality-adjusted life year (QALYs) were 17.11, 18.40 and 20.20, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $25,707.90/QALY and $14,543.08/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis. Conclusions We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.
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Affiliation(s)
- Qing Yang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaorong Zhong
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu, 610040, Sichuan, China.
| | - Ting Luo
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ping He
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Zheng
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, China
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Kuang XW, Sun ZH, Song JL, Zhu Z, Chen C. Comparison of the ductal carcinoma in situ between White Americans and Chinese Americans. Medicine (Baltimore) 2021; 100:e24136. [PMID: 33546026 PMCID: PMC7837883 DOI: 10.1097/md.0000000000024136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Currently, the wide-spread use of screening mammography has led to dramatic increases in ductal carcinoma in situ (DCIS). However, DCIS of Chinese Americans, the largest Asian subgroup in American, has rarely been comprehensively studied over the past decade. This work compared the DCIS characteristics and prognosis of Chinese American patients with White Americans in the USA to determine the characteristics and prognosis of DCIS patients of Chinese Americans.The data were obtained using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. The diagnosis and treatment variables between the two groups were compared by means of Chi-square tests. Survival was determined with the use of the Kaplan-Meier method and the multivariable Cox proportional hazard regression model.From 1975 to 2016, 81,745 White Americans and 2069 Chinese Americans were diagnosed with ductal carcinoma in situ. Compared with the white patients, the Chinese Americans were younger (P < .001) with smaller tumors (P < .001) and higher family income (P < .001). DCIS patients of Chinese American group accounted for a higher percentage of all breast cancers than the whites (P < .001). In the multivariable Cox proportional hazard regression analysis, Chinese American was an independent favorable prognostic factor in terms of overall survival (OS) (HR, 0.684; 95% CI, 0.593-0.789; P < .001) compared with the white group.In conclusion, DCIS characteristics of the Chinese group, which exhibited a higher proportion of younger age, a higher DCIS ratio, and a better prognosis, were distinct from those of the White Americans.
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Affiliation(s)
| | | | | | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
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21
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Almahariq MF, Quinn TJ, Siddiqui Z, Jawad MS, Chen PY, Gustafson GS, Dilworth JT. Breast conserving therapy is associated with improved overall survival compared to mastectomy in early-stage, lymph node-negative breast cancer. Radiother Oncol 2020; 142:186-194. [DOI: 10.1016/j.radonc.2019.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 01/02/2023]
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22
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Taheri M, Tavakol M, Akbari ME, Anoshirvani AA, Aghabozorgi R, Almasi-Hashiani A, Abbasi M. Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E262-E269. [PMID: 31650064 PMCID: PMC6797882 DOI: 10.15167/2421-4248/jpmh2019.60.3.1162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
Introduction This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC). Methods This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software. Results Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), – 0.014 (– 0.034, – 0.001) and – 0.042 (– 0.061, – 0.002) for metastasis, recurrence, stage and grade of BC respectively. Conclusions Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.
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Affiliation(s)
- M Taheri
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Tavakol
- Sociology Department, School of Social Sciences, University of Tehran, Tehran, Iran
| | - M E Akbari
- Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A A Anoshirvani
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - R Aghabozorgi
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - A Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - M Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Prognostic Impact of Breast-Conserving Therapy Versus Mastectomy of BRCA1/2 Mutation Carriers Compared With Noncarriers in a Consecutive Series of Young Breast Cancer Patients. Ann Surg 2019; 270:364-372. [DOI: 10.1097/sla.0000000000002804] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Lan XW, Wen G, He Z, Huang JH, Zou XB, Lin X, Tan YT, Huang XB. Comparison of long-term results between radiotherapy after breast-conserving surgery and postmastectomy radiotherapy in stage T1-2N1M0 breast cancer. Cancer Manag Res 2019; 11:6477-6487. [PMID: 31372049 PMCID: PMC6636609 DOI: 10.2147/cmar.s209634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Postoperative radiotherapy (RT) can improve survival for T1-2N1 breast cancer. However, there exists a concern whether BCS plus RT has the same or a superior therapeutic effect as that of mastectomy. In this study, we aimed to compare the long-term results between RT after BCS and postmastectomy RT in stage T1-2N1M0 breast cancer. Patients and Methods Totally 1816 pathological stage T1-2N1M0 breast cancer patients were analyzed. The propensity score matching (PSM) method was used to select 196 pairs of patients between BCS and mastectomy receiving postoperative RT. Five-year locoregional relapse (LRR), locoregional relapse-free survival (LRFS), distant metastasis (DM), distant metastasis-free survival (DMFS), disease-free survival (DFS), breast cancer-specific survival (BCSS) were analyzed as endpoints. Results In the whole group, significant differences were observed in all endpoints (P<0.05) between the no-RT and RT groups. For patients receiving mastectomy, DM, DMFS, DFS and BCSS rates had no differences between the two groups. For patients without RT in the multivariable analysis, the molecular subtype was associated with each endpoint (P<0.05). Age, primary tumor site, tumor size, and LVI status were significantly associated with DM. The analysis of 196 pairs of patients selected by PSM showed that BCS plus RT resulted in a significantly lower 5-year DM rate (P=0.015) and superior survival in terms of the 5-year DMFS (P=0.046), DFS (P=0.049) and BCSS (P=0.024) compared with mastectomy. Conclusions Postoperative radiotherapy remarkably improved survival in T1-2N1M0 breast cancer but not in the mastectomy subgroup, except for LRR and LRFS. Patients with BCS plus RT had better survival compared with those with postmastectomy radiation in terms of DM, DMFS, DFS and BCSS.
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Affiliation(s)
- Xiao-Wen Lan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Ge Wen
- Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, People's Republic of China
| | - Zhen He
- Department of Oncology, The First Affiliation Hospital of Guangdong Pharmaceutical University, Guangzhou 510062, People's Republic of China
| | - Jiang-Hua Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Xue-Bin Zou
- Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong 510060, People's Republic of China
| | - Xiao Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Yu-Ting Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
| | - Xiao-Bo Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China.,Department of Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, People's Republic of China
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Landercasper J, Ramirez LD, Borgert AJ, Ahmad HF, Parsons BM, Dietrich LL, Linebarger JH. A Reappraisal of the Comparative Effectiveness of Lumpectomy Versus Mastectomy on Breast Cancer Survival: A Propensity Score–Matched Update From the National Cancer Data Base (NCDB). Clin Breast Cancer 2019; 19:e481-e493. [DOI: 10.1016/j.clbc.2019.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022]
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Gutiérrez-Diez PJ, López-Marcos MÁ, Martínez-Rodríguez J, Russo J. The effects of time valuation in cancer optimal therapies: a study of chronic myeloid leukemia. Theor Biol Med Model 2019; 16:10. [PMID: 31138288 PMCID: PMC6540446 DOI: 10.1186/s12976-019-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/07/2019] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND The mathematical design of optimal therapies to fight cancer is an important research field in today's Biomathematics and Biomedicine given its relevance to formulate patient-specific treatments. Until now, however, cancer optimal therapies have considered that malignancy exclusively depends on the drug concentration and the number of cancer cells, ignoring that the faster the cancer grows the worse the cancer is, and that early drug doses are more prejudicial. Here, we analyze how optimal therapies are affected when the time evolution of treated cancer is envisaged as an additional element determining malignancy, analyzing in detail the implications for imatinib-treated Chronic Myeloid Leukemia. METHODS Taking as reference a mathematical model describing Chronic Myeloid Leukemia dynamics, we design an optimal therapy problem by modifying the usual malignancy objective function, unaware of any temporal dimension of cancer malignance. In particular, we introduce a time valuation factor capturing the increase of malignancy associated to the quick development of the disease and the persistent negative effects of initial drug doses. After assigning values to the parameters involved, we solve and simulate the model with and without the new time valuation factor, comparing the results for the drug doses and the evolution of the disease. RESULTS Our computational simulations unequivocally show that the consideration of a time valuation factor capturing the higher malignancy associated with early growth of cancer and drug administration allows more efficient therapies to be designed. More specifically, when this time valuation factor is incorporated into the objective function, the optimal drug doses are lower, and do not involve medically relevant increases in the number of cancer cells or in the disease duration. CONCLUSIONS In the light of our simulations and as biomedical evidence strongly suggests, the existence of a time valuation factor affecting malignancy in treated cancer cannot be ignored when designing cancer optimal therapies. Indeed, the consideration of a time valuation factor modulating malignancy results in significant gains of efficiency in the optimal therapy with relevant implications from the biomedical perspective, specially when designing patient-specific treatments.
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Affiliation(s)
- Pedro José Gutiérrez-Diez
- Department of Economic Theory and IMUVA, Faculty of Economics, Avda. Valle Esgueva 6, University of Valladolid, Valladolid, 47011, Spain.
| | - Miguel Ángel López-Marcos
- Department of Applied Mathematics and IMUVA, Faculty of Science, University of Valladolid, Paseo de Belén 7, Valladolid, 47011, Spain
| | - Julia Martínez-Rodríguez
- Department of Applied Economics and IMUVA, Faculty of Economics, University of Valladolid, Avda. Valle Esgueva 6, Valladolid, 47011, Spain
| | - Jose Russo
- Director of the Breast Cancer Research Laboratory, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, 19111-2497, PA, USA
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van Maaren MC, le Cessie S, Strobbe LJA, Groothuis-Oudshoorn CGM, Poortmans PMP, Siesling S. Different statistical techniques dealing with confounding in observational research: measuring the effect of breast-conserving therapy and mastectomy on survival. J Cancer Res Clin Oncol 2019; 145:1485-1493. [PMID: 31020418 DOI: 10.1007/s00432-019-02919-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Propensity trimming, hierarchical modelling and instrumental variable (IV) analysis are statistical techniques dealing with confounding, cluster-related variation or confounding by severity. This study aimed to explain (dis)advantages of these techniques in estimating the effect of breast-conserving therapy (BCT) and mastectomy on 10-year distant metastasis-free survival (DMFS). METHODS All women diagnosed in 2005 with primary T1-2N0-1 breast cancer treated with BCT or mastectomy were selected from the Netherlands Cancer Registry. We used multivariable Cox regression to correct for confounding. Propensity trimming was used to create a more homogeneous population for which the treatment choice was not self-evident. Hospital of surgery was used as hierarchical level to handle hospital-related variation, and as IV to deal with unmeasured confounding. RESULTS Multivariable Cox regression showed higher 10-year DMFS for BCT than mastectomy [HR 0.70 (95% CI 0.60-82)]. Propensity trimming on the 10-90th and the 20-80th percentile of the propensity score distribution and hierarchical modelling showed similar HRs. IV analysis showed no significant difference between BCT and mastectomy. CONCLUSION Unmeasured confounding is very difficult to eliminate in observational research. We cannot conclude that BCT or mastectomy has a causal relationship with 10-year DMFS. It is crucial to critically evaluate all model's assumptions, and to be careful in drawing firm conclusions.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Wang J, Deng JP, Sun JY, Dong Y, Zhang WW, He ZY, Wu SG. Noninferior Outcome After Breast-Conserving Treatment Compared to Mastectomy in Breast Cancer Patients With Four or More Positive Lymph Nodes. Front Oncol 2019; 9:143. [PMID: 30931256 PMCID: PMC6423330 DOI: 10.3389/fonc.2019.00143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/19/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: We conducted a non-inferiority analysis using real-world data to compare the survival outcomes of stage T1-2N2-3 (tumor size ≤5 cm and four or more node metastases) breast cancer after breast-conserving surgery (BCS) and mastectomy (MAST). Methods: The study included patients with stage T1-2N2-3 invasive breast carcinoma from the Surveillance, Epidemiology, and End Results program, who underwent BCS or MAST between 2004 and 2012, along with both radiotherapy and chemotherapy. The statistical analyses used included the chi-squared test, multivariate Cox proportional hazards models, and propensity score matching (PSM). Results: The study population comprised 13,263 patients, including 4,787 (36.1%) and 8,476 (63.9%) patients who were treated with BCS and MAST, respectively. Patients with younger age and advanced stage were more likely to have received MAST. The probability of receiving MAST increased over the years, while the probability of BCS decreased (p < 0.001). The 5-year breast cancer-specific survival (BCSS) was 86.1% in the BCS cohort compared to 83.1% in the MAST cohort (p < 0.001). Surgical procedure was an independent prognostic factor for BCSS. Patients who received MAST had worse BCSS than those treated with BCS (hazard ratio = 1.179, 95% confidence interval = 1.087-1.278, p < 0.001). These results remained significant after stratification by age, tumor grade, T stage, N stage as well as marital status. Similar results were obtained after PSM. Conclusions: BCS resulted in noninferior outcome than MAST in patients with T1-2/N2-3 invasive breast carcinoma. BCS may therefore be an optimal treatment option when both treatment options are feasible and appropriate.
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Affiliation(s)
- Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Jia-Peng Deng
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jia-Yuan Sun
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yong Dong
- Department of Oncology, Dongguan Third People's Hospital, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China
| | - Wen-Wen Zhang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Zhen-Yu He
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
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Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases. Cancers (Basel) 2019; 11:cancers11020160. [PMID: 30709048 PMCID: PMC6406394 DOI: 10.3390/cancers11020160] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 12/19/2022] Open
Abstract
Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.
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Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation. Int J Radiat Oncol Biol Phys 2019; 103:78-80. [DOI: 10.1016/j.ijrobp.2018.07.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 11/19/2022]
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Survival following breast-conserving therapy is equal to that following mastectomy in young women with early-stage invasive lobular carcinoma. Eur J Surg Oncol 2018; 44:1703-1707. [PMID: 30029824 DOI: 10.1016/j.ejso.2018.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/13/2018] [Accepted: 06/12/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Previous observational studies reported the superior survival of patients with early-stage breast cancer who underwent breast-conserving therapy (BCT, lumpectomy plus postsurgical radiation) compared to that of those who underwent mastectomy. Invasive lobular carcinoma (ILC) is not the same disease as invasive ductal carcinoma (IDC) as it has distinct biologic features and thus requires unique consideration and research. METHODS We selected women (≤50 years of age) from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with stage T1-2, N0-1, M0 primary breast cancer with invasive lobular features between 1998 and 2011, that were treated with either BCT or mastectomy with and without radiation. We assessed survival proportions using the Kaplan-Meier method and hazard ratios using Cox proportional hazards models. Breast cancer-specific survival (BCSS) served as the primary endpoint. RESULTS A total of 3393 eligible young ILC patients were identified, 1391 (41%) of which underwent lumpectomy followed by radiation. The 10-year BCSS rates for patients who received BCT, mastectomy alone and mastectomy with radiation were 95.7%, 94.2% and 89.3%, respectively. Multivariate analysis showed that BCSS was not improved in patients assigned to mastectomy alone group (HR = 0.86; 95% CI 0.57-1.28) or mastectomy with postsurgical radiation group (HR = 0.97; 95% CI 0.58-1.62) compared to that in those who underwent BCT. The results did not changed when evaluating the 1998-2004 and 2005-2011 time periods separately. CONCLUSION None of the treatment demonstrated an absolute superiority in young women with early-stage ILC. Future studies with more detailed analyses of the confounding factors are worthwhile.
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Fisher S, Yasui Y, Dabbs K, Winget M. Re-excision and survival following breast conserving surgery in early stage breast cancer patients: a population-based study. BMC Health Serv Res 2018; 18:94. [PMID: 29422097 PMCID: PMC5806481 DOI: 10.1186/s12913-018-2882-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/23/2018] [Indexed: 11/12/2022] Open
Abstract
Background Increasing population-based evidence suggests that patients who receive breast conserving surgery (BCS) plus radiotherapy have superior survival than those who receive mastectomy. It is unclear, however, how BCS followed by re-excision is associated with all-cause and breast cancer-specific mortality, and whether the BCS survival advantage is maintained if re-excision is needed. The aim of this study was to investigate the clinical, patient, provider and geographic variation associated with receipt of re-excision surgery, and to examine the relationship between re-excision and all-cause and breast cancer-specific mortality. Methods All women diagnosed with stage I-III breast cancer in Alberta, Canada from 2002 to 2009 were identified from the Alberta Cancer Registry, of which 11,626 were eligible for study inclusion. Type of first breast cancer surgery after diagnosis, subsequent re-excisions within 1 year, surgeon (anonymized), and hospital were obtained from provincial physician claims data. Multilevel logistic regression with surgeons and hospitals as crossed random effects was used to estimate the adjusted odds ratios of re-excision by the factors of interest. Poisson regression models were fitted to compare all-cause and breast cancer-specific mortality by surgical pattern. Results Re-excision surgery was received by 19% (N = 5659) of patients who initially received BCS. The adjusted odds of re-excision varied significantly by geography of surgery, and by individual surgeon among stage I and II patients beyond the variation explained by the factors investigated (Stage I OR standard deviation (SD) = 0.43; stage II OR SD = 0.39). Patients who were treated with BCS plus re-excision surgery with either mastectomy or further BCS had similar all-cause and breast cancer-specific mortality as those treated with BCS without re-excision. Conclusion These results suggest that breast cancer patients who are treated with BCS plus re-excision surgery by either mastectomy or further BCS have similar survival as those treated with BCS without re-excision. The significant variation in the likelihood of re-excision by geography and by individual surgeon is concerning, especially given the costs to the patient associated with additional surgery and the financial costs to the health system.
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Affiliation(s)
- Stacey Fisher
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Kelly Dabbs
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Marcy Winget
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada. .,Department of Medicine, School of Medicine, Stanford University, 1265 Welch Rd, Room X214, Stanford, California, 94305, USA.
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Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A, Jensen MB. Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 2018; 57:19-25. [PMID: 29168674 DOI: 10.1080/0284186x.2017.1403042] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. METHODS The cohort included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995-2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients who primarily had BCS and then mastectomy [intention to treat (ITT) by BCS]. The association between overall mortality and standard mortality ratio (SMR) and risk factors was analyzed in univariate and multivariate Poisson regression models. RESULTS A total of 58,331 patients were included: 27,143 in the mastectomy group, 26,958 in the BCS group, and 4230 in the BCS-ITT group. After adjusting for patient and treatment characteristics, the relative risk (RR) was 1.20 (95% CI: 1.15-1.25) after mastectomy and 1.08 (95% CI: 1.01-1.15) after BCS first and then mastectomy, as compared to BCS. Statistically significant interactions were not observed for age, period of treatment, and nodal status, but patients with Charlson's Comorbidity Index (CCI) score 2+ had no increased mortality after mastectomy, as opposed to patients with CCI 0-1. Loco-regional radiation therapy (RT) in node positive patients did not reduce the increased risk associated with mastectomy [RR = 1.28 (95% CI 1.19-1.38)]. CONCLUSION Patients assigned to BCS have a better survival than patients assigned to mastectomy. Residual confounding after adjustment for registered characteristics presumably explained the different outcomes, thus consistent with selection bias. Diversities in RT did not appear to explain the observed difference in survival after BCS and mastectomy.
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Affiliation(s)
- Peer Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
| | - Stina Lyck Carstensen
- Danish Breast Cancer Cooperative Group Secretariat, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group Secretariat, Department of Oncology, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Herlev, Denmark
| | | | - Anne Bodilsen
- Department of Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group Secretariat, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
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Lagendijk M, van Maaren MC, Saadatmand S, Strobbe LJ, Poortmans PM, Koppert LB, Tilanus-Linthorst MM, Siesling S. Breast conserving therapy and mastectomy revisited: Breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer 2017; 142:165-175. [DOI: 10.1002/ijc.31034] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Mirelle Lagendijk
- Department of Surgical Oncology; Erasmus MC Cancer Institute, 3075 EA; Rotterdam The Netherlands
| | - Marissa C. van Maaren
- Department of Research; Netherlands Comprehensive Cancer Organisation, 3511 DT; Utrecht The Netherlands
- Department of Health Technology & Services Research; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, 7500 EA; Enschede The Netherlands
| | - Sepideh Saadatmand
- Department of Surgery; Maxima Medical Center, 5504 DB; Veldhoven The Netherlands
| | - Luc J.A. Strobbe
- Department of Surgical Oncology; Canisius Wilhelmina Hospital, 6532 SZ; Nijmegen The Netherlands
| | - Philip M.P. Poortmans
- Department of Radiation Oncology; Institut Curie, 26, Rue d'Ulm, 75248 Paris cedex 05; France
| | - Linetta B. Koppert
- Department of Surgical Oncology; Erasmus MC Cancer Institute, 3075 EA; Rotterdam The Netherlands
| | | | - Sabine Siesling
- Department of Research; Netherlands Comprehensive Cancer Organisation, 3511 DT; Utrecht The Netherlands
- Department of Health Technology & Services Research; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, 7500 EA; Enschede The Netherlands
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[Breast-conserving surgery plus adjuvant radiotherapy better than mastectomy? : The 10-year survival data from the Netherlands]. Strahlenther Onkol 2017; 193:344-346. [PMID: 28246698 DOI: 10.1007/s00066-017-1111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nandakumar A, Rath GK, Kataki AC, Bapsy PP, Gupta PC, Gangadharan P, Mahajan RC, Bandyopadhyay MN, Swamy K, Vallikad E, Visweswara RN, Roselind FS, Sathishkumar K, Kumar DDV, Jain A, Sudarshan KL. Decreased Survival With Mastectomy Vis-à-Vis Breast-Conserving Surgery in Stage II and III Breast Cancers: A Comparative Treatment Effectiveness Study. J Glob Oncol 2016; 3:304-313. [PMID: 28831438 PMCID: PMC5560451 DOI: 10.1200/jgo.2016.004614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose The primary purpose of hospital-based cancer registries is assessing patient care. Clinical stage–based survival and treatment-based survival are some of the key parameters for such assessment. Because of the challenges in obtaining follow-up parameters, a separate study on patterns of care and survival was undertaken by the Indian National Cancer Registry Program. The results for cancer of the female breast are presented here. Patients and Methods Data abstracted in a standardized patient information form were transmitted online to a central repository. Treatment patterns were assessed for 9,903 patients diagnosed between January 1, 2006, and December 31, 2008, from 13 institutions. Survival analysis was restricted to 7,609 patients from nine institutions wherein follow-up details (as of December 31, 2012) were available for at least 60% of patients. Results The overall 5-year survival rates with breast-conserving surgery (BCS) and mastectomy (MS) were 94.0% and 85.8%, respectively, for stage II disease (adjusted hazard ratio, 2.40; 95% CI, 1.8 to 3.2) and 87.1% and 69.0%, respectively, for stage III disease (hazard ratio, 2.82; 95% CI, 2.2 to 3.7). Patients who had MS did better with systemic therapy (chemotherapy and/or hormone therapy), whereas patients with BCS required just local radiation therapy to achieve best survival. Conclusion This observational study in the natural setting of care of patients with cancer in India showed significantly decreased survival with MS when compared with BCS. The reasons for lower survival with MS and the biologic or scientific rationale of the necessity of systemic therapy to achieve optimal survival in patients undergoing MS but not in those with BCS need further investigation.
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Affiliation(s)
- Ambakumar Nandakumar
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Goura Kishor Rath
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Amal Chandra Kataki
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - P Poonamalle Bapsy
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Prakash C Gupta
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Paleth Gangadharan
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Ramesh C Mahajan
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Manas Nath Bandyopadhyay
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Kumara Swamy
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Elizabeth Vallikad
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Rudrapatna N Visweswara
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Francis Selvaraj Roselind
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Krishnan Sathishkumar
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Dampilla Daniel Vijay Kumar
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Ankush Jain
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
| | - Kondalli Lakshminarayana Sudarshan
- , , , , , , National Centre for Disease Informatics and Research; , Apollo Hospitals; , HealthCare Global-Bangalore Institute of Oncology; , St John's Medical College; , International Medical School-MS Ramaiah Medical College, Bangalore; , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi; , Dr B.B. Borooah Cancer Institute, Guwahati; , Healis-Sekhsaria Institute of Public Health, Navi Mumbai; , Amrita Institute of Medical Sciences and Research Centre, Kochi; , Postgraduate Institute of Medical Education and Research, Chandigarh; and , Cancer Centre Welfare Home and Research Institute, Kolkata, India
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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 2016; 160:511-521. [DOI: 10.1007/s10549-016-4012-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: A NCDB analysis. Oncotarget 2016; 6:40127-40. [PMID: 26517676 PMCID: PMC4741884 DOI: 10.18632/oncotarget.5394] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/29/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose Recent studies have revealed that breast-conserving surgery (BCS) with radiotherapy (RT) led to better survival than mastectomy in some populations. We compared the efficacy of BCS+RT and mastectomy using the National Cancer Database (NCDB, USA). Methods Non-metastatic breast cancers in the NCDB from 2004–2011 were identified. The Kaplan-Meier method, Coxregression and propensity score analysis were used to compare the overall survival (OS) among patients with BCS+RT, mastectomy alone and mastectomy+RT. Results A total of 160,880 patients with a median follow-up of 43.4 months were included. The respective 8-year OS values were 86.5%, 72.3% and 70.4% in the BCS+RT, mastectomy alone and mastectomy+RT group, respectively (P < 0.001). After exclusion of patients with comorbidities, mastectomy (alone or with RT) remained associated with a lower OS in N0 and N1 patients. However, the OS of mastectomy+RT was equivalent to BCS+RT in N2–3 patients. Among patients aged 50 or younger, the OS benefit of BCS+RT over mastectomy alone was statistically significant (HR1.42, 95% CI 1.16–1.74), but not clinically significant (<5%) in N0 patients, whereas in N2–3 patients, the OS of BCS+RT was equivalent to mastectomy+RT (85.2% vs. 84.8%). The results of the propensity analysis were similar. Conclusions BCS+RT resulted in improved OS compared with mastectomy ± RT in N0 and N1 patients. In N2–3 patients, BCS+RT has an OS similar to mastectomy+RT when patients with comorbidities were excluded. Among patients aged 50 or younger, the OS of BCS+RT is equivalent to mastectomy ± RT.
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Courneya KS, McNeely ML, Culos-Reed SN, Vallance JK, Bell GJ, Mackey JR, Matthews CE, Morielli AR, Cook D, MacLaughlin S, Farris MS, Voaklander S, O'Reilly R, Friedenreich CM. The Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study: Recruitment, Baseline Assessment, and Description of the First 500 Participants. BMC Cancer 2016; 16:481. [PMID: 27416835 PMCID: PMC4946114 DOI: 10.1186/s12885-016-2534-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, the Alberta Moving Beyond Breast Cancer (AMBER) Study is the first and only prospective cohort study of breast cancer survivors that includes objectively-measured physical activity (PA), sedentary behavior, health-related fitness (HRF), and biologic mechanisms focused on understanding breast cancer outcomes. The purpose of the present study was to report on the feasibility of recruitment, baseline measurement completion, and the representativeness of the first 500 participants. METHODS AMBER is enrolling newly diagnosed stage I (≥T1c) to IIIc breast cancer survivors in Alberta, Canada. Baseline assessments are completed soon after diagnosis and include cardiorespiratory fitness, musculoskeletal fitness, body composition, objective and self-reported PA and sedentary behavior, lymphedema, and blood collection. RESULTS Between July 2012 and November 2014, AMBER recruited its first 500 participants from a pool of 1,447 (35 %) eligible breast cancer survivors. Baseline HRF assessments were completed on ≥85 % of participants with the exception of upper body strength. Collection of ≥4 days/week of monitoring for the Actigraph GT3X® and ActivPAL® were obtained from 90 % of participants. Completion rates were also high for blood (99 %), lymphedema (98 %), and questionnaires (95 %) including patient-reported outcomes and correlates of exercise. The first 500 participants in AMBER are an average age of 56 years, 60 % are overweight or obese, and 58 % have disease stage II or III. CONCLUSION Despite the modest recruitment rate and younger age, AMBER has demonstrated that many newly diagnosed breast cancer survivors are willing and able to complete a wide array of sophisticated and physically demanding HRF and PA assessments soon after diagnosis. AMBER is a unique breast cancer survivor cohort that may inform future randomized controlled trials on lifestyle and breast cancer outcomes as well as PA behavior change in breast cancer survivors. Moreover, AMBER may also inform guidelines on PA, sedentary behavior, and HRF for improving breast cancer outcomes and survivorship.
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Affiliation(s)
- Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada.
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Gordon J Bell
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - John R Mackey
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, USA
| | - Andria R Morielli
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Diane Cook
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Sarah MacLaughlin
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Megan S Farris
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Stephanie Voaklander
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Rachel O'Reilly
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
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Laurberg T, Lyngholm CD, Christiansen P, Alsner J, Overgaard J. Long-term age-dependent failure pattern after breast-conserving therapy or mastectomy among Danish lymph-node-negative breast cancer patients. Radiother Oncol 2016; 120:98-106. [DOI: 10.1016/j.radonc.2016.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 11/15/2022]
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van Maaren MC, de Munck L, de Bock GH, Jobsen JJ, van Dalen T, Linn SC, Poortmans P, Strobbe LJA, Siesling S. 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 2016; 17:1158-1170. [PMID: 27344114 DOI: 10.1016/s1470-2045(16)30067-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery plus radiotherapy might be overestimated. In this study, we aimed to evaluate 10 year overall and breast cancer-specific survival after breast-conserving surgery plus radiotherapy compared with mastectomy in Dutch women with early breast cancer. METHODS In this population-based study, we selected all women from the Netherlands Cancer Registry diagnosed with primary, invasive, stage T1-2, N0-1, M0 breast cancer between Jan 1, 2000, and Dec 31, 2004, given either breast-conserving surgery plus radiotherapy or mastectomy, irrespective of axillary staging or dissection or use of adjuvant systemic therapy. Primary outcomes were 10 year overall survival in the entire cohort and breast cancer-specific survival in a representative subcohort of patients diagnosed in 2003 with characteristics similar to the entire cohort. We estimated breast cancer-specific survival by calculating distant metastasis-free and relative survival for every tumour and nodal category. We did multivariable Cox proportional hazard analysis to estimate hazard ratios (HRs) for overall and distant metastasis-free survival. We estimated relative survival by calculating excess mortality ratios using life tables of the general population. We did multiple imputation to account for missing data. FINDINGS Of the 37 207 patients included in this study, 21 734 (58%) received breast-conserving surgery plus radiotherapy and 15 473 (42%) received mastectomy. The 2003 representative subcohort consisted of 7552 (20%) patients, of whom 4647 (62%) received breast-conserving surgery plus radiotherapy and 2905 (38%) received mastectomy. For both unadjusted and adjusted analysis accounting for various confounding factors, breast-conserving surgery plus radiotherapy was significantly associated with improved 10 year overall survival in the whole cohort overall compared with mastectomy (HR 0·51 [95% CI 0·49-0·53]; p<0·0001; adjusted HR 0·81 [0·78-0·85]; p<0·0001), and this improvement remained significant for all subgroups of different T and N stages of breast cancer. After adjustment for confounding variables, breast-conserving surgery plus radiotherapy did not significantly improve 10 year distant metastasis-free survival in the 2003 cohort overall compared with mastectomy (adjusted HR 0·88 [0·77-1·01]; p=0·07), but did in the T1N0 subgroup (adjusted 0·74 [0·58-0·94]; p=0·014). Breast-conserving surgery plus radiotherapy did significantly improve 10 year relative survival in the 2003 cohort overall (adjusted 0·76 [0·64-0·91]; p=0·003) and in the T1N0 subgroup (adjusted 0·60 [0·42-0·85]; p=0·004) compared with mastectomy. INTERPRETATION Adjusting for confounding variables, breast-conserving surgery plus radiotherapy showed improved 10 year overall and relative survival compared with mastectomy in early breast cancer, but 10 year distant metastasis-free survival was improved with breast-conserving surgery plus radiotherapy compared with mastectomy in the T1N0 subgroup only, indicating a possible role of confounding by severity. These results suggest that breast-conserving surgery plus radiotherapy is at least equivalent to mastectomy with respect to overall survival and may influence treatment decision making for patients with early breast cancer. FUNDING None.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jan J Jobsen
- Department of Radiation Oncology, Medical Spectrum Twente, Enschede, Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Pathology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.
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Liu J, Chen K, Mao K, Su F, Liu Q, Jacobs LK. The prognostic value of age for invasive lobular breast cancer depending on estrogen receptor and progesterone receptor-defined subtypes: A NCDB analysis. Oncotarget 2016; 7:6063-73. [PMID: 26515602 PMCID: PMC4868740 DOI: 10.18632/oncotarget.5844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/15/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We aimed to assess the effect of age on survival according to estrogen receptor (ER) and progesterone receptor (PR)-defined lobular breast cancer subtype in a wide age range. METHODS 43,230 invasive lobular breast cancer women without comorbidities diagnosed between 2004 and 2011 in the National Cancer Database (NCDB) were analyzed. The effects of age on overall survival (OS) among different age groups were evaluated by log-rank test and Cox proportional model. RESULTS Multivariate analysis showed that patients diagnosed at both young (< 35 years) and old (≥ 70 years) ages had worse prognosis compared with those in the middle ages. We further analyzed the interaction between age and molecular subtype for predicting OS: in ER+PR+ subtype, the HR of OS declined with age from 1.55 (95% CI, 1.08-2.22; P = 0.019) in the group younger than 35 years to 1.38 (1.02-1.86; P = 0.036) in the 35-39 group, but increased with age to 10.1 (8.49-11.94; P < 0.001) in the group older than 79. While in ER+PR- and ER-PR- subtypes, the HRs showed no statistical differences among women diagnosed before 60 (P > 0.1); and in ER-PR+ subgroup, the HRs were similar in patients younger than 70 (P > 0.1); thus, the plots of HRs in these three subtypes remained steady until the age of 60 or 70. CONCLUSIONS Our findings identified that the effect of age on OS in lobular breast cancer varied with ER/PR-defined subtypes. Personalized treatment strategies should be developed to improve outcomes of breast cancer patients with different ages and ER/PR statuses.
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Affiliation(s)
- Jieqiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kai Mao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of General Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiang Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lisa K. Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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