Value of breast-conserving surgery plus radiotherapy <i>versus</i> mastectomy in Chinese young early breast cancer patients_West China Medical Journal

Authors：

XU Ningyue ¹ , WANG Jun ¹ ,  LIU Lei ¹ ,  LUO Ting ²

1. Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Breast Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Lei, Email: liuleihx@gmail.com; LUO Ting, Email: luoting@wchscu.cn

Keywords：

Young breast cancer; breast-conserving surgery; mastectomy; radiotherapy; survival analysis

DOI：

10.7507/1002-0179.202402174

Video：

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Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.

1.	Schlichting JA, Soliman AS, Schairer C, et al. Breast cancer by age at diagnosis in the Gharbiah, Egypt, population-based registry compared to the United States Surveillance, Epidemiology, and End Results Program, 2004-2008. Biomed Res Int, 2015, 2015: 381574.
2.	Guo R, Si J, Xue J, et al. Changing patterns and survival improvements of young breast cancer in China and SEER database, 1999 - 2017. Chin J Cancer Res, 2019, 31(4): 653-662.
3.	郑莹, 吴春晓, 张敏璐. 乳腺癌在中国的流行状况和疾病特征. 中国癌症杂志, 2013, 23(8): 561-569.
4.	Yankaskas BC. Epidemiology of breast cancer in young women. Breast Dis, 2005, 23: 3-8.
5.	Gnerlich JL, Deshpande AD, Jeffe DB, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg, 2009, 208(3): 341-347.
6.	郑荣寿, 陈茹, 韩冰峰, 等. 2022 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.
7.	Chen K, Pan Z, Zhu L, et al. Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis. Sci China Life Sci, 2018, 61(12): 1528-1536.
8.	Fu J, Wu L, Fu W, et al. How young is too young in breast cancer?-Young breast cancer is not a unique biological subtype. Clin Breast Cancer, 2018, 18(1): e25-e39.
9.	Zouzoulas D, Tsolakidis D, Gitas G, et al. Breast cancer in women younger than 35 years old. Arch Gynecol Obstet, 2020, 302(3): 721-730.
10.	Wang W, Tian B, Xu X, et al. Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study. Arch Gynecol Obstet, 2023, 307(3): 957-968.
11.	Morrison DH, Rahardja D, King E, et al. Tumour biomarker expression relative to age and molecular subtypes of invasive breast cancer. Br J Cancer, 2012, 107(2): 382-387.
12.	Keegan TH, DeRouen MC, Press DJ, et al. Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res, 2012, 14(2): R55.
13.	Anders CK, Johnson R, Litton J, et al. Breast cancer before age 40 years. Semin Oncol, 2009, 36(3): 237-249.
14.	Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 2008, 26(20): 3324-3330.
15.	Recio-Saucedo A, Gerty S, Foster C, et al. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: a systematic review. Breast, 2016, 25: 1-13.
16.	Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg, 2015, 150(1): 9-16.
17.	Bhoo-Pathy N, Subramaniam S, Taib NA, et al. Spectrum of very early breast cancer in a setting without organised screening. Br J Cancer, 2014, 110(9): 2187-2194.
18.	Teo SY, Chuwa E, Latha S, et al. Young breast cancer in a specialised breast unit in Singapore: clinical, radiological and pathological factors. Ann Acad Med Singap, 2014, 43(2): 79-85.
19.	Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: a systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
20.	Coulombe G, Tyldesley S, Speers C, et al. Is mastectomy superior to breast-conserving treatment for young women?. Int J Radiat Oncol Biol Phys, 2007, 67(5): 1282-1290.
21.	Cao JQ, Truong PT, Olivotto IA, et al. Should women younger than 40 years of age with invasive breast cancer have a mastectomy? 15-year outcomes in a population-based cohort. Int J Radiat Oncol Biol Phys, 2014, 90(3): 509-517.
22.	Jeon YW, Choi JE, Park HK, et al. Impact of local surgical treatment on survival in young women with T1 breast cancer: long-term results of a population-based cohort. Breast Cancer Res Treat, 2013, 138(2): 475-484.
23.	Han J, Grothuesmann D, Neises M, et al. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet, 2010, 282(1): 75-82.
24.	Sherman KA, Woon S, French J, et al. Body image and psychological distress in nipple-sparing mastectomy: the roles of self-compassion and appearance investment. Psychooncology, 2017, 26(3): 337-345.
25.	Kim MK, Kim T, Moon HG, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol, 2015, 41(3): 426-432.
26.	Cardoso F, Loibl S, Pagani O, et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer, 2012, 48(18): 3355-3377.
27.	Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
28.	van Maaren MC, de Munck L, de Bock GH, et al. 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(8): 1158-1170.
29.	Christiansen P, Carstensen SL, Ejlertsen B, et al. 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(1): 19-25.
30.	Agarwal S, Pappas L, Neumayer L, et al. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg, 2014, 149(3): 267-274.
31.	Waks AG, Winer EP. Breast cancer treatment: a review. JAMA, 2019, 321(3): 288-300.
32.	Curran D, van Dongen JP, Aaronson NK, et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer, 1998, 34(3): 307-314.
33.	Nissen MJ, Swenson KK, Ritz LJ, et al. Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer, 2001, 91(7): 1238-1246.
34.	Arndt V, Stegmaier C, Ziegler H, et al. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol, 2008, 134(12): 1311-1318.
35.	Hwang ES, Lichtensztajn DY, Gomez SL, et al. Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer, 2013, 119(7): 1402-1411.
36.	Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129, 692 patients. Int J Cancer, 2018, 142(1): 165-175.
37.	Mcguire A, Brown JA, Malone C, et al. Effects of age on the detection and management of breast cancer. Cancers (Basel), 2015, 7(2): 908-929.
38.	Collins LC, Marotti JD, Gelber S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat, 2012, 131(3): 1061-1066.

1. Schlichting JA, Soliman AS, Schairer C, et al. Breast cancer by age at diagnosis in the Gharbiah, Egypt, population-based registry compared to the United States Surveillance, Epidemiology, and End Results Program, 2004-2008. Biomed Res Int, 2015, 2015: 381574.
2. Guo R, Si J, Xue J, et al. Changing patterns and survival improvements of young breast cancer in China and SEER database, 1999 - 2017. Chin J Cancer Res, 2019, 31(4): 653-662.
3. 郑莹, 吴春晓, 张敏璐. 乳腺癌在中国的流行状况和疾病特征. 中国癌症杂志, 2013, 23(8): 561-569.
4. Yankaskas BC. Epidemiology of breast cancer in young women. Breast Dis, 2005, 23: 3-8.
5. Gnerlich JL, Deshpande AD, Jeffe DB, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg, 2009, 208(3): 341-347.
6. 郑荣寿, 陈茹, 韩冰峰, 等. 2022 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2024, 46(3): 221-231.
7. Chen K, Pan Z, Zhu L, et al. Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis. Sci China Life Sci, 2018, 61(12): 1528-1536.
8. Fu J, Wu L, Fu W, et al. How young is too young in breast cancer?-Young breast cancer is not a unique biological subtype. Clin Breast Cancer, 2018, 18(1): e25-e39.
9. Zouzoulas D, Tsolakidis D, Gitas G, et al. Breast cancer in women younger than 35 years old. Arch Gynecol Obstet, 2020, 302(3): 721-730.
10. Wang W, Tian B, Xu X, et al. Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study. Arch Gynecol Obstet, 2023, 307(3): 957-968.
11. Morrison DH, Rahardja D, King E, et al. Tumour biomarker expression relative to age and molecular subtypes of invasive breast cancer. Br J Cancer, 2012, 107(2): 382-387.
12. Keegan TH, DeRouen MC, Press DJ, et al. Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res, 2012, 14(2): R55.
13. Anders CK, Johnson R, Litton J, et al. Breast cancer before age 40 years. Semin Oncol, 2009, 36(3): 237-249.
14. Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol, 2008, 26(20): 3324-3330.
15. Recio-Saucedo A, Gerty S, Foster C, et al. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: a systematic review. Breast, 2016, 25: 1-13.
16. Kummerow KL, Du L, Penson DF, et al. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg, 2015, 150(1): 9-16.
17. Bhoo-Pathy N, Subramaniam S, Taib NA, et al. Spectrum of very early breast cancer in a setting without organised screening. Br J Cancer, 2014, 110(9): 2187-2194.
18. Teo SY, Chuwa E, Latha S, et al. Young breast cancer in a specialised breast unit in Singapore: clinical, radiological and pathological factors. Ann Acad Med Singap, 2014, 43(2): 79-85.
19. Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: a systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
20. Coulombe G, Tyldesley S, Speers C, et al. Is mastectomy superior to breast-conserving treatment for young women?. Int J Radiat Oncol Biol Phys, 2007, 67(5): 1282-1290.
21. Cao JQ, Truong PT, Olivotto IA, et al. Should women younger than 40 years of age with invasive breast cancer have a mastectomy? 15-year outcomes in a population-based cohort. Int J Radiat Oncol Biol Phys, 2014, 90(3): 509-517.
22. Jeon YW, Choi JE, Park HK, et al. Impact of local surgical treatment on survival in young women with T1 breast cancer: long-term results of a population-based cohort. Breast Cancer Res Treat, 2013, 138(2): 475-484.
23. Han J, Grothuesmann D, Neises M, et al. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet, 2010, 282(1): 75-82.
24. Sherman KA, Woon S, French J, et al. Body image and psychological distress in nipple-sparing mastectomy: the roles of self-compassion and appearance investment. Psychooncology, 2017, 26(3): 337-345.
25. Kim MK, Kim T, Moon HG, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol, 2015, 41(3): 426-432.
26. Cardoso F, Loibl S, Pagani O, et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer, 2012, 48(18): 3355-3377.
27. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
28. van Maaren MC, de Munck L, de Bock GH, et al. 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(8): 1158-1170.
29. Christiansen P, Carstensen SL, Ejlertsen B, et al. 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(1): 19-25.
30. Agarwal S, Pappas L, Neumayer L, et al. Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg, 2014, 149(3): 267-274.
31. Waks AG, Winer EP. Breast cancer treatment: a review. JAMA, 2019, 321(3): 288-300.
32. Curran D, van Dongen JP, Aaronson NK, et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer, 1998, 34(3): 307-314.
33. Nissen MJ, Swenson KK, Ritz LJ, et al. Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer, 2001, 91(7): 1238-1246.
34. Arndt V, Stegmaier C, Ziegler H, et al. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol, 2008, 134(12): 1311-1318.
35. Hwang ES, Lichtensztajn DY, Gomez SL, et al. Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer, 2013, 119(7): 1402-1411.
36. Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129, 692 patients. Int J Cancer, 2018, 142(1): 165-175.
37. Mcguire A, Brown JA, Malone C, et al. Effects of age on the detection and management of breast cancer. Cancers (Basel), 2015, 7(2): 908-929.
38. Collins LC, Marotti JD, Gelber S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat, 2012, 131(3): 1061-1066.

West China Medical Journal

Latest ArticlesValue of breast-conserving surgery plus radiotherapy versus mastectomy in Chinese young early breast cancer patients

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