Long-Term Outcome of Breast-Conserving Therapy Versus Mastectomy Therapy for Early Stage Invasive Breast Cancer: Result of Meta Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CAO Feng , LI Fei

Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China;

Corresponding author：

Keywords：

Breast cancer; Breast-conserving surgery; Mastectomy; Meta analysis

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Objective To compare the long-term outcome between breast-conserving therapy with mastectomy therapy for early stage invasive breast cancer through a Meta analysis of the randomized controlled trials published worldwide. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and so on. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicators for assessment including death number at the end of follow-up, locoregional and total recurrence. The results were analyzed with RevMan 4.2.2 software. Results Six articles were involved in the Meta analysis with total 3 933 patients. No statistical difference was found in the death at the end of follow-up between breast-conserving therapy group and mastectomy therapy group (OR=1.05, 95% CI=0.93—1.19， P=0.45). Locoregional and total recurrence rate of breast-conserving therapy group were statistical higher than those in mastectomy therapy group (OR=1.64, 95% CI: 1.10—2.44， P=0.01； OR=1.42, 95% CI: 1.22—1.64， P lt;0.01). Conclusions Breast-conserving therapy and mastectomy therapy have comparable effects on mortality in patient with early stage invasive breast cancer, even after long-term follow up. However, breast-conserving therapy is associated with significantly greater risk of locoregional recurrence.

Citation： CAO Feng,LI Fei. Long-Term Outcome of Breast-Conserving Therapy Versus Mastectomy Therapy for Early Stage Invasive Breast Cancer: Result of Meta Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 601-605. doi: Copy

1.	Halsted WS. Ⅰ. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894 [J]. Ann Surg, 1894; 20(5): 497-555.
2.	Fisher B. Breast cancer [J]. Postgrad Med, 1969; 45(4): 73-78.
3.	Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the Cancer Institute of Milan [J]. Cancer, 1977; 39(6 Suppl): 2822-2826.
4.	Fisher B, Wolmark N, Fisher ER, et al. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations [J]. World J Surg, 1985; 9(5): 692-698.
5.	Keynes G. The radium treatment of carcinoma of the breast [J]. Br J Surg, 1932, 19(75): 415-480.
6.	钟颖, 孙强, 徐雅莉, 等. 30年乳腺癌治疗趋势的变化 [J]. 中国普外基础与临床杂志, 2009; 16(11): 911-917.
7.	袁家宾, 林洋, 刘洪, 等. 早期乳腺癌保乳手术的疗效分析 [J]. 中国普外基础与临床杂志, 2008; 15(7): 477-478.
8.	Consensus Development Panel. NIH Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Bethesda, Maryland, June 18-21, 1990 [J]. J Natl Cancer Inst Monogr, 1992; (11): 1-187.
9.	王深明, 姚陈. 乳腺癌保乳手术的若干问题探讨 [J]. 中华外科杂志, 2009; 47(7): 494-496.
10.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J] . Control Clin Trials, 1996; 17(1): 1-12.
11.	Blichert-Toft M, Nielsen M, Düring M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol [J]. Acta Oncol, 2008; 47(4): 672-681.
12.	Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial [J]. Cancer, 2003; 98(4): 697-702.
13.	Lichter AS, Lippman ME, Danforth DN Jr, et al. Mastectomy versus breast-conserving therapy in the treatment of stage Ⅰ and Ⅱ carcinoma of the breast: a randomized trial at the National Cancer Institute [J]. J Clin Oncol, 1992; 10(6): 976-983.
14.	Straus K, Lichter A, Lippman M, et al. Results of the National Cancer Institute early breast cancer trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 27-32.
15.	Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med, 2002; 347(16): 1227-1232.
16.	Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast [J]. N Engl J Med, 1981; 305(1): 6-11.
17.	Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1989; 320(13): 822-828.
18.	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 [J]. N Engl J Med, 2002; 347(16): 1233-1241.
19.	van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stageⅠ and Ⅱbreast cancer [J]. Eur J Cancer, 1992; 28A(4-5): 801-805.
20.	van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage Ⅰ and Ⅱ breast cancer, EORTC 10801 trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 15-18.
21.	van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial [J]. J Natl Cancer Inst, 2000; 92(14): 1143-1150.
22.	Arriagada R, Lê MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group [J]. J Clin Oncol, 1996; 14(5): 1558-1564.
23.	Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results [J]. Am J Clin Oncol, 2005; 28(3): 289-294.
24.	Johansen J, Overgaard J, Rose C, et al. On behalf of DBCG. Cosmetic outcome and breast morbidity in breast-conserving treatment-results from the Danish DBCG-82TM national randomized trial in breast cancer [J]. Acta Oncol, 2002; 41(4): 369-380.
25.	张保宁. 乳腺癌保乳手术的研究进展 [J]. 中国普外基础与临床杂志, 2005; 12(3): 204-206.
26.	杨春明. 乳腺癌治疗的现代概念 [J]. 中国普外基础与临床杂志, 2008; 15(7): 467-470.

1. Halsted WS. Ⅰ. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889, to January, 1894 [J]. Ann Surg, 1894; 20(5): 497-555.
2. Fisher B. Breast cancer [J]. Postgrad Med, 1969; 45(4): 73-78.
3. Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the Cancer Institute of Milan [J]. Cancer, 1977; 39(6 Suppl): 2822-2826.
4. Fisher B, Wolmark N, Fisher ER, et al. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations [J]. World J Surg, 1985; 9(5): 692-698.
5. Keynes G. The radium treatment of carcinoma of the breast [J]. Br J Surg, 1932, 19(75): 415-480.
6. 钟颖, 孙强, 徐雅莉, 等. 30年乳腺癌治疗趋势的变化 [J]. 中国普外基础与临床杂志, 2009; 16(11): 911-917.
7. 袁家宾, 林洋, 刘洪, 等. 早期乳腺癌保乳手术的疗效分析 [J]. 中国普外基础与临床杂志, 2008; 15(7): 477-478.
8. Consensus Development Panel. NIH Consensus Development Conference on the Treatment of Early-Stage Breast Cancer. Bethesda, Maryland, June 18-21, 1990 [J]. J Natl Cancer Inst Monogr, 1992; (11): 1-187.
9. 王深明, 姚陈. 乳腺癌保乳手术的若干问题探讨 [J]. 中华外科杂志, 2009; 47(7): 494-496.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J] . Control Clin Trials, 1996; 17(1): 1-12.
11. Blichert-Toft M, Nielsen M, Düring M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol [J]. Acta Oncol, 2008; 47(4): 672-681.
12. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial [J]. Cancer, 2003; 98(4): 697-702.
13. Lichter AS, Lippman ME, Danforth DN Jr, et al. Mastectomy versus breast-conserving therapy in the treatment of stage Ⅰ and Ⅱ carcinoma of the breast: a randomized trial at the National Cancer Institute [J]. J Clin Oncol, 1992; 10(6): 976-983.
14. Straus K, Lichter A, Lippman M, et al. Results of the National Cancer Institute early breast cancer trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 27-32.
15. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer [J]. N Engl J Med, 2002; 347(16): 1227-1232.
16. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast [J]. N Engl J Med, 1981; 305(1): 6-11.
17. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1989; 320(13): 822-828.
18. 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 [J]. N Engl J Med, 2002; 347(16): 1233-1241.
19. van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stageⅠ and Ⅱbreast cancer [J]. Eur J Cancer, 1992; 28A(4-5): 801-805.
20. van Dongen JA, Bartelink H, Fentiman IS, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage Ⅰ and Ⅱ breast cancer, EORTC 10801 trial [J]. J Natl Cancer Inst Monogr, 1992; (11): 15-18.
21. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial [J]. J Natl Cancer Inst, 2000; 92(14): 1143-1150.
22. Arriagada R, Lê MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group [J]. J Clin Oncol, 1996; 14(5): 1558-1564.
23. Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results [J]. Am J Clin Oncol, 2005; 28(3): 289-294.
24. Johansen J, Overgaard J, Rose C, et al. On behalf of DBCG. Cosmetic outcome and breast morbidity in breast-conserving treatment-results from the Danish DBCG-82TM national randomized trial in breast cancer [J]. Acta Oncol, 2002; 41(4): 369-380.
25. 张保宁. 乳腺癌保乳手术的研究进展 [J]. 中国普外基础与临床杂志, 2005; 12(3): 204-206.
26. 杨春明. 乳腺癌治疗的现代概念 [J]. 中国普外基础与临床杂志, 2008; 15(7): 467-470.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Long-Term Outcome of Breast-Conserving Therapy Versus Mastectomy Therapy for Early Stage Invasive Breast Cancer: Result of Meta Analysis

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