Breast-conserving surgery exhibits potential superior Overall Survival compared to mastectomy: JAMA

A study focusing on Chinese patients who underwent surgery for breast cancer shed light on the clinical characteristics and prognosis of this population. The JAMA study involved a review of medical records spanning from January 2009 to September 2017 with a median follow-up of nearly 8 years, aimed to evaluate overall survival (OS) and disease-free survival (DFS) while delving into histopathology and surgical approaches.

The study, including 14,782 patients (99.6% female; mean age 51.6 years), found invasive ductal carcinoma (IDC) to be the predominant type, affecting 85.6% of patients. The disease was distributed across various stages: 6.4% were at stage 0, 32.0% at stage I, 40.5% at stage II, 20.2% at stage III, and 0.9% at stage IV. Hormone receptor (HR) positivity was observed in 75.1% of patients, with 29.1% testing positive for ERBB2.

The results highlight the diversity in breast cancer subtypes. The HR-negative–ERBB2-negative, HR-negative–ERBB2-positive, HR-positive–ERBB2-negative, and HR-positive–ERBB2-positive subtypes constituted 13.3%, 12.7%, 57.8%, and 16.2% of cases, respectively.

In terms of surgical approaches, breast-conserving surgery (BCS) was performed in 19.5% of cases, indicating that mastectomy remains the more prevalent choice in China.

Survival rates at 5 and 10 years were encouraging, with OS rates at 92.9% and 87.4%, and DFS rates at 89.0% and 82.9%, respectively. Multivariate analysis revealed several factors associated with OS and DFS, including age, tumor characteristics, lymphovascular invasion, and hormone receptor status.

One striking finding was that after propensity score matching, BCS was found to be as effective as mastectomy for patients with IDC. This suggests the importance of considering breast-conserving surgery as a treatment option, potentially offering better cosmetic outcomes and quality of life for patients without compromising survival.

The study's significance lies in its provision of insights into the histopathological characteristics and survival outcomes of Chinese breast cancer patients. The diversity in breast cancer subtypes underscores the importance of personalized treatment strategies, emphasizing the need for targeted therapies tailored to the specific characteristics of each case.

Furthermore, the relatively low utilization of breast-conserving surgery in the study population indicates the necessity for increased awareness and adoption of this approach, considering its potential advantages for survival.

Source:

Liu, G., Kong, X., Dai, Q., Cheng, H., Wang, J., Gao, J., & Wang, Y. (2023). Clinical Features and Prognoses of Patients With Breast Cancer Who Underwent Surgery. In JAMA Network Open (Vol. 6, Issue 8, p. e2331078). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.31078