1
|
Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. Survival outcomes after breast cancer surgery among older women with early invasive breast cancer in England: population-based cohort study. BJS Open 2024; 8:zrae062. [PMID: 38976577 PMCID: PMC11229699 DOI: 10.1093/bjsopen/zrae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND This study assessed the influence of age, co-morbidity and frailty on 5-year survival outcomes after breast conservation surgery (BCS) with radiotherapy (RT) versus mastectomy (with or without RT) in women with early invasive breast cancer. METHODS Women aged over 50 years with early invasive breast cancer diagnosed in England (2014-2019) who had breast surgery were identified from Cancer Registry data. Survival estimates were calculated from a flexible parametric survival model. A competing risk approach was used for breast cancer-specific survival (BCSS). Standardized survival probabilities and cumulative incidence functions for breast cancer death were calculated for each treatment by age. RESULTS Among 101 654 women, 72.2% received BCS + RT and 27.8% received mastectomy. Age, co-morbidity and frailty were associated with overall survival (OS), but only age and co-morbidity were associated with BCSS. Survival probabilities for OS were greater for BCS + RT (90.3%) versus mastectomy (87.0%), and the difference between treatments varied by age (50 years: 1.9% versus 80 years: 6.5%). Cumulative incidence functions for breast cancer death were higher after mastectomy (5.1%) versus BCS + RT (3.9%), but there was little change in the difference by age (50 years: 0.9% versus 80 years: 1.2%). The results highlight the change in baseline mortality risk by age for OS compared to the stable baseline for BCSS. CONCLUSION For OS, the difference in survival probabilities for BCS + RT and mastectomy increased slightly with age. The difference in cumulative incidence functions for breast cancer death by surgery type was small regardless of age. Evidence on real-world survival outcomes among older populations with breast cancer is informative for treatment decision-making.
Collapse
Affiliation(s)
- Katie Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Clements
- The National Disease Registration Service, NHS England, Birmingham, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Min Hae Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Washington I, Palm RF, White J, Rosenberg SA, Ataya D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers (Basel) 2024; 16:2122. [PMID: 38893241 PMCID: PMC11171236 DOI: 10.3390/cancers16112122] [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: 04/22/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy.
Collapse
Affiliation(s)
- Iman Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Russell F. Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Julia White
- Department of Radiation Oncology, The University of Kansas Medical Center, 4001 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Stephen A. Rosenberg
- Department of Radiation Therapy, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dana Ataya
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 10920 N. McKinley Drive, Tampa, FL 33612, USA;
| |
Collapse
|
3
|
Rajan KK, Fairhurst K, Birkbeck B, Novintan S, Wilson R, Savović J, Holcombe C, Potter S. Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis. BJS Open 2024; 8:zrae040. [PMID: 38758563 PMCID: PMC11100524 DOI: 10.1093/bjsopen/zrae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Breast-conserving surgery with adjuvant radiotherapy and mastectomy are currently offered as equivalent surgical options for early-stage breast cancer based on RCTs from the 1970s and 1980s. However, the treatment of breast cancer has evolved and recent observational studies suggest a survival advantage for breast-conserving surgery with adjuvant radiotherapy. A systematic review and meta-analysis was undertaken to summarize the contemporary evidence regarding survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for women with early-stage breast cancer. METHODS A systematic search of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase that identified studies published between 1 January 2000 and 18 December 2023 comparing overall survival after breast-conserving surgery with adjuvant radiotherapy versus mastectomy for patients with unilateral stage 1-3 breast cancer was undertaken. The main exclusion criteria were studies evaluating neoadjuvant chemotherapy, rare breast cancer subtypes, and specific breast cancer populations. The ROBINS-I tool was used to assess risk of bias, with the overall certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Studies without critical risk of bias were included in a quantitative meta-analysis. RESULTS From 11 750 abstracts, 108 eligible articles were identified, with one article including two studies; 29 studies were excluded from the meta-analysis due to an overall critical risk of bias, 42 studies were excluded due to overlapping study populations, and three studies were excluded due to reporting incompatible results. A total of 35 observational studies reported survival outcomes for 909 077 patients (362 390 patients undergoing mastectomy and 546 687 patients undergoing breast-conserving surgery with adjuvant radiotherapy). The pooled HR was 0.72 (95% c.i. 0.68 to 0.75, P < 0.001), demonstrating improved overall survival for patients undergoing breast-conserving surgery with adjuvant radiotherapy. The overall certainty of the evidence was very low. CONCLUSION This meta-analysis provides evidence suggesting a survival advantage for women undergoing breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer compared with mastectomy. Although these results should be interpreted with caution, they should be shared with patients to support informed surgical decision-making.
Collapse
Affiliation(s)
- Kiran K Rajan
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Fairhurst
- Bristol Medical School, University of Bristol, Bristol, UK
- Linda McCartney Centre, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Beth Birkbeck
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Rebecca Wilson
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jelena Savović
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Shelley Potter
- Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
4
|
Zhygulin A, Fedosov A. Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5789. [PMID: 38712017 PMCID: PMC11073777 DOI: 10.1097/gox.0000000000005789] [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: 11/27/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
Background Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. Methods This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. Results A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Conclusions Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.
Collapse
Affiliation(s)
- Andrii Zhygulin
- From the Breast Center, LISOD Hospital of Israeli Oncology, Kyiv, Ukraine
| | - Artem Fedosov
- From the Breast Center, LISOD Hospital of Israeli Oncology, Kyiv, Ukraine
- Breast Unit, Innovacia Clinic, Kyiv, Ukraine
| |
Collapse
|
5
|
Vasilyeva E, Nichol A, Bakos B, Barton A, Goecke M, Lam E, Martin E, Lohrisch C, McKevitt E. Breast conserving surgery combined with radiation therapy offers improved survival over mastectomy in early-stage breast cancer. Am J Surg 2024; 231:70-73. [PMID: 37246127 DOI: 10.1016/j.amjsurg.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Landmark trials established equivalent survival regardless of extent of breast surgery in early-stage breast cancer. However, recent studies suggest a survival advantage for breast conserving surgery (BCS) with radiotherapy (BCT). This study assesses the impact of type of surgery on overall survival (OS), breast cancer specific survival (BCSS) and local recurrence (LR) in a modern population-based cohort. METHODS Female patients aged ≥18, pT1-2pN0, who had surgery between 2006 and 2016 were identified from Breast Cancer Outcome Unit prospective database. Neoadjuvant chemotherapy patients were excluded. Multivariable Cox regression was used to assess the effect of surgical procedure on OS, BCSS, and LR on cohort with complete data. RESULTS BCT was performed in 8422 patients and TM in 4034 patients. The baseline characteristics differed between the groups. Mean follow up was 8.3 years. BCT was associated with increased OS HR 1.37, p < 0.001, BCSS survival HR 1.49, p < 0.001, and similar LR HR 1.00, p > 0.90. CONCLUSION This study supports that in early-stage breast cancer, BCT has improved BCSS compared to TM without an increased risk of LR.
Collapse
Affiliation(s)
- Elizaveta Vasilyeva
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Alan Nichol
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Brendan Bakos
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Anise Barton
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Goecke
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Lam
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Erin Martin
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Caroline Lohrisch
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Elaine McKevitt
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
6
|
Mokbel K. Unlocking the Power of the Homing Phenomenon: Why Breast Conserving Surgery Outshines Mastectomy in Overall Survival. Clin Breast Cancer 2024; 24:85-92. [PMID: 37925361 DOI: 10.1016/j.clbc.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Breast cancer stands as the most frequently diagnosed malignancy in women, holding a prominent position among the leading causes of cancer-related fatalities on a global scale. Despite significant advances in treatment modalities, approximately 20% of patients experience relapses after the first 5 years of postdiagnosis surveillance. While initial investigations from the 1970s indicated comparable survival rates between breast-conserving surgery (BCS) coupled with radiation therapy and mastectomy, recent research suggests that, within the context of modern systemic and radiation therapy, BCS followed by radiation may offer an improved overall survival benefit. Nevertheless, extended follow-up studies have unveiled a notable increase in the risk of locoregional recurrence associated with breast conserving therapy in contrast to mastectomy. This article introduces a novel hypothesis rooted in the biological phenomenon of homing to elucidate this intriguing clinical observation. We postulate that a breast homing mechanism of reactivated circulating and disseminated tumor cells mediated by chemotaxis involving at least the CXCR4-SDF-1 axis may provide a biological rationale for this clinical phenomenon.
Collapse
Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, W1U 5NY, UK.
| |
Collapse
|
7
|
Moreno-Palacios E, Martí C, Frías L, Meléndez M, Loayza A, Roca MJ, Córdoba V, Oliver JM, Hernández A, Sánchez-Méndez JI. Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience. Cancers (Basel) 2024; 16:566. [PMID: 38339317 PMCID: PMC10854709 DOI: 10.3390/cancers16030566] [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: 12/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics. METHODS We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens. RESULTS Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins. CONCLUSION In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.
Collapse
Affiliation(s)
- Elisa Moreno-Palacios
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Covadonga Martí
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Laura Frías
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Marcos Meléndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - Adolfo Loayza
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - María José Roca
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Vicenta Córdoba
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - José María Oliver
- Radiology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (M.J.R.); (V.C.); (J.M.O.)
| | - Alicia Hernández
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| | - José Ignacio Sánchez-Méndez
- Obstetrics and Gynecology Department, Breast Unit H Universitario La Paz, 28046 Madrid, Spain; (C.M.); (L.F.); (M.M.); (A.L.); (A.H.); (J.I.S.-M.)
| |
Collapse
|
8
|
Binici S, Güven M, Özdemir A, İlik ZA, Demirhan B, Uygur S, İliklerden ÜH. Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management. Histochem Cell Biol 2024:10.1007/s00418-024-02267-z. [PMID: 38282055 DOI: 10.1007/s00418-024-02267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
Collapse
Affiliation(s)
- Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Abdulselam Özdemir
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| | - Zehra Akman İlik
- Department of Pathology, Van Education and Research Hospital, Van, Turkey
| | - Birhan Demirhan
- Faculty of Medicine, Department of Radiation Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Ümit Haluk İliklerden
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| |
Collapse
|
9
|
Zaher HAE, Fathy H, Abozeid M, Faisal M. Neoadjuvant chemotherapy for stage II-III breast cancer: a single-center experience. World J Surg Oncol 2023; 21:314. [PMID: 37805553 PMCID: PMC10559473 DOI: 10.1186/s12957-023-03199-z] [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: 10/07/2022] [Accepted: 09/19/2023] [Indexed: 10/09/2023] Open
Abstract
INTRODUCTION We conducted this study to reflect a single-center experience with the use of neoadjuvant systemic chemotherapy (NAC) for the management of women with operable breast cancer. METHODS We conducted a retrospective chart review on all women presenting with operable, stage II-III, breast cancer and were scheduled for NAC at Suez Canal University Hospital. The primary outcome of this study was to estimate the proportion of patients with breast cancer who become eligible for breast-conserving surgery (BCS) after (NAC). RESULTS A total of 147 patients were included. Before the initiation of chemotherapy, only 66 (44.9%) patients were indicated for (BCS). A total of 40 (49.4%) new patients, out of the 81 patients who were ineligible before chemotherapy, became eligible for BCS after NAC (95% CI 39.3-61.9%). On the other hand, 8 (12.1%) patients became ineligible for BCS after NAC, out of 66 patients who were initially eligible. Out of the 98 eligible patients for BCS after chemotherapy, 72 (73.5%) patients underwent the surgery, and the remaining 26 (26.5%) patients chose modified radical mastectomy (MRM). A total of 55 out of 72 (76.4%) patients achieved pathological complete response (pCR). One woman (0.1%) experienced relapse in the 3rd year of follow-up and three women (2%) experienced relapse in the 5th year of follow-up. We found a statistically significant relationship between patients who became eligible for breast-conserving surgery and both age and estrogen receptor negativity (p = 0.001 and 0.007, respectively). CONCLUSION NAC can play a crucial role in increasing the rate of eligibility for BCS among women with operable, stage II-III, breast cancer.
Collapse
Affiliation(s)
- Haidi Abd El Zaher
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
| | - Hamada Fathy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt
| | - Mohamed Abozeid
- Department of Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohammed Faisal
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt.
- Department of General Surgery, Torsby Hospital, Region Värmland County Council, Värmland, Sweden.
| |
Collapse
|
10
|
Vasilyeva E, Hamm J, Nichol A, Isaac KV, Bazzarelli A, Brown C, Lohrisch C, McKevitt E. Breast-Conserving Therapy is Associated with Improved Survival Without an Increased Risk of Locoregional Recurrence Compared with Mastectomy in Both Clinically Node-Positive and Node-Negative Breast Cancer Patients. Ann Surg Oncol 2023; 30:6413-6424. [PMID: 37358683 DOI: 10.1245/s10434-023-13784-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Randomized trials demonstrated equivalent survival between breast-conserving surgery combined with radiotherapy (BCT) and mastectomy alone. Contemporary retrospective studies using pathological stage have reported improved survival with BCT. However, pathological information is unknown before surgery. To mimic real-world surgical decision-making, this study assesses oncological outcomes by using clinical nodal status. METHODS Female patients aged 18-69 years who were treated with upfront BCT or mastectomy between 2006 and 2016 for T1-3N0-3 breast cancer were identified by using prospective, provincial database. The patients were divided into clinically node-positive (cN+) and node-negative (cN0) strata. Multivariable logistic regression was used to assess the effect of local treatment type on overall survival (OS), breast cancer-specific survival (BCSS), and locoregional recurrence (LRR). RESULTS Of 13,914 patients, 8228 had BCT and 5686 had mastectomy. Mastectomy patients had higher-risk clinicopathological factors: pathologically positive axillary staging was 21% in BCT and 38% in mastectomy groups. Most patients received adjuvant systemic therapy. For cN0 patients, 7743 had BCT and 4794 had mastectomy. On multivariable analysis, BCT was associated with improved OS (hazard ratio [HR] 1.37, p < 0.001) and BCSS (HR 1.32, p < 0.001), whereas LRR was not different between the groups (HR 0.84, p = 0.1). For cN+ patients, 485 had BCT and 892 had mastectomy. On multivariable analysis, BCT was associated with improved OS (HR 1.46, p = 0.002) and BCSS (HR 1.44, p = 0.008), whereas LRR was not different between the groups (HR 0.89, p = 0.7). CONCLUSIONS In the era of contemporary systemic therapy, BCT was associated with better survival than mastectomy, without an increased risk of locoregional recurrence for both cN0 and cN+ presentations.
Collapse
Affiliation(s)
- Elizaveta Vasilyeva
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer, Vancouver, BC, Canada.
| | | | - Alan Nichol
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Kathryn V Isaac
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Amy Bazzarelli
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Carl Brown
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Caroline Lohrisch
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Elaine McKevitt
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| |
Collapse
|
11
|
Sanz J, Eraso A, Ibáñez R, Williams R, Algara M. Tumor Bed Boost Radiotherapy in the Conservative Treatment of Breast Cancer: A Review of Intra-Operative Techniques and Outcomes. Cancers (Basel) 2023; 15:4025. [PMID: 37627053 PMCID: PMC10452620 DOI: 10.3390/cancers15164025] [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: 07/03/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Conservative surgery is the preferred treatment in the management of breast cancer followed by adjuvant whole-breast irradiation. Since the tumor bed is the main site of relapse, boost doses are conveniently administered according to risk factors for local relapse to increase the efficacy of the treatment. The benefit of a radiation boost is well established and it can be performed by several techniques like brachytherapy, external radiation or intraoperative radiotherapy. Greater precision in localizing the tumor cavity, immediacy and increased biological response are the main advantages of intraoperative boost irradiation. This modality of treatment can be performed by means of mobile electron accelerators or low-photon X-ray devices. There is a lot of research and some published series analyzing the results of the use of an intraoperative boost as an adjuvant treatment, after neoadjuvant systemic therapy and in combination with some reconstructive surgeries. This review discusses advantages of intraoperative radiotherapy and presents the main results of a boost in terms of local control, survival, tolerance and cosmesis.
Collapse
Affiliation(s)
- Javier Sanz
- Radiation Oncology Department, Hospital del Mar Barcelona, 08003 Barcelona, Spain
- Facultat de Medicina, Campus del Mar, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Arantxa Eraso
- Radiation Oncology Department, Institut Català d’Oncologia, Hospital Trueta, 17007 Girona, Spain;
- Facultat de Medicina, Campus Centre, Universitat de Girona, 17004 Girona, Spain
| | - Reyes Ibáñez
- Radiation Oncology Department, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Rachel Williams
- College of Liberal Arts, Texas A&M University, College Station, TX 77843, USA;
| | - Manuel Algara
- Radiation Oncology Department, Hospital del Mar Barcelona, 08003 Barcelona, Spain
- Facultat de Medicina, Campus del Mar, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| |
Collapse
|
12
|
Fernando H, Noelia G, Maria E, Pedro M. Centrally located breast carcinomas treated with central quadrantectomy and immediate nipple-areola reconstruction: a cohort study. Breast Cancer 2023; 30:552-558. [PMID: 36867348 DOI: 10.1007/s12282-023-01445-6] [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: 12/20/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Mastectomy has often been cited as the favoured option for centrally located breast tumours because lumpectomies or quadrantectomies that remove the nipple-areola complex often result in poor cosmesis. Currently, breast-conserving treatment is a preferred treatment for centrally located breast tumours, but this approach requires oncoplastic breast technique to avoid aesthetic sequels. This article describes the use of breast reduction techniques with immediate nipple-areola complex reconstruction (utilised to treat breast cancer) for centrally sited breast tumours PATIENTS: Ten patients suffering from a centrally located breast carcinoma were treated at our breast unit over a period of 16 years (2006-2022). Oncologic and patient-reported outcomes were updated revising electronic reports and surveying with BREAST-Q module Breast conserving therapy (version 2, Spanish) postoperative scales. RESULTS Excision margins were complete in all cases. There have been no postoperative complications, all patients are alive and no cases of recurrence after 84.8 months of mean follow-up. Patients score the domain satisfaction with breast: mean 61.7 (Standard deviation 12.5) out of 100. CONCLUSIONS Breast reduction mammaplasty with immediate nipple-areola complex reconstruction allows surgeons to carry out a central quadrantectomy to treat centrally located breast carcinoma with good oncologic and cosmetic outcome.
Collapse
Affiliation(s)
- Hernanz Fernando
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain.
| | - González Noelia
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain
| | - Esteban Maria
- Breast Unit, Hospital Valdecilla, University of Cantabria, Avda. Valdecilla Sn, 39008, Santander, Cantabria, Spain
| | - Muñoz Pedro
- Servicio Cántabro de Salud (SCS), Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
| |
Collapse
|
13
|
Sopik V, Lim D, Sun P, Narod SA. Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy. Curr Oncol 2023; 30:3829-3844. [PMID: 37185403 PMCID: PMC10136458 DOI: 10.3390/curroncol30040290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Many women with early-stage breast cancer are predicted to be at sufficiently low risk for recurrence that they may forego chemotherapy. Nevertheless, some low-risk women will experience a local recurrence, and for them the risk of death increases significantly thereafter. The utility of initiating chemotherapy at the time of local recurrence has not been adequately addressed. The purpose of this study is to identify, in a hospital-based series of patients with early-stage breast cancer who were not treated with chemotherapy, those factors which predict death post local recurrence. Methods: We identified 135 women who were diagnosed with early-stage breast cancer (node-negative, <5 cm) and who did not receive chemotherapy at diagnosis and who developed a local recurrence. They were diagnosed between 1987 and 2000 and treated at Women’s College Hospital. For each patient, we abstracted information on the initial cancer (age at diagnosis, tumour size, tumour grade, ER status, PR status, HER2 status, lympho-vascular invasion, type of surgery, use of radiotherapy, tamoxifen and chemotherapy), the time from initial diagnosis to local recurrence and treatment at recurrence. The Kaplan–Meier method was used to estimate the ten-year actuarial risk of breast cancer death post recurrence. A Cox proportional hazards model was used to estimate multivariate hazard ratios for the various factors. Results: Among the 135 women in the cohort, the mean time from initial diagnosis to local recurrence was 7.8 years (range: 0.3 to 22.6 years). A total of 38 of the 135 women (28.1%) died of breast cancer a mean of 5.3 years after experiencing the local recurrence (range: 0.3 to 17 years). The ten-year breast cancer survival post local recurrence was 71% and the 15-year survival was 65%. In a multivariate analysis, it was found that factors that were significantly associated with death after local recurrence were (1) PR-negative status, (2) young age at diagnosis (<40 years) and (3) time to local recurrence less than 2 years. Nine percent of women received chemotherapy at the time of local recurrence. Conclusions: For breast cancer patients with a low baseline risk of mortality, the risk of death after an isolated local recurrence is substantial. Systemic treatment at the time of local recurrence needs further study.
Collapse
|
14
|
Whole Breast Irradiation Versus Intraoperative Electron Radiation Therapy for Breast Conserving Therapy: A Large Mature Single Institution Matched-Pair Evaluation of True Local Relapse, Progression Free Survival, and Overall Survival. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00098-6. [PMID: 36736632 DOI: 10.1016/j.ijrobp.2023.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Comparative outcome data after intraoperative radiation therapy and whole breast irradiation (WBI) for breast cancer at >10 years median follow-up are rare. We present a mature, single-institution, matched-pair comparison reporting survival and relapse rates in patients treated with either modality. METHODS AND MATERIALS Complete data sets for 258 intraoperative electron radiation therapy (IOERT) patients treated between 2000 and 2010 were matched with 258 patients postoperatively treated with WBI by age/histology/tumor size, grading/lymph-node-status/hormone receptors/type of adjuvant therapy/surgical margins, and treatment date. Relapse at surgical intervention site was classified as true local recurrence (LR). All recurrences in the treated breast (any quadrant) were classified as ipsilateral recurrence (IR). RESULTS Median follow-up was 157 months (12-251) for the IOERT group and 154 months (31-246) for the WBI group. Cumulative incidence of IR at 5, 10, and 15 years was 2.4%, 7.9%, and 12.7% for IOERT and 1.2%, 4.1%, and 5.0% for WBI (P = .02). Cumulative incidence of LR at 5, 10, and 15 years was 1.6%, 5.1%, and 8.3% for IOERT and 0.4%, 2.1%, and 2.5% for WBI (P = .02). No differences in overall survival, disease-free survival, second cancer incidence, or cardiac events were recorded in either treatment group. Outcome was better in the accelerated partial breast irradiation (APBI)-suitable group than in the APBI-unsuitable group (2009 criteria) (cumulative incidence of IR at 5, 10, and 15 years was 0% vs 7.3%, 6.1% vs 13.3%, and 7.3% vs 19.9% for IOERT and 0% vs 1.8%, 2.0% vs 3.9%, and 3.1% vs 3.9% for WBI) and in the revised APBI-suitable group than in the APBI-cautionary group (2017 criteria) (cumulative incidence of IR at 5, 10, and 15 years was 1.1% vs 6.4%, 6.2% vs 13.3%, and 7.8% vs 27.5% for IOERT and 1.7% vs 0%, 4.1% vs 4.4%, and 5.4% vs 4.4% for WBI). CONCLUSIONS The IR and LR rate were higher after IOERT than after WBI for the American Society for Radiation Oncology suitable patient group, although without reaching statistical significance. Thus, IOERT could be an alternative to WBI upon stringent patient selection, but patients should be counseled carefully about the potential for increased IR rate with IOERT. Second cancer incidence and cardiac events did not differ between IOERT and WBI.
Collapse
|
15
|
Postoperative Radiotherapy Contributes to the Survival Benefit of Breast-Conserving Therapy over Mastectomy. JOURNAL OF ONCOLOGY 2022; 2022:4145872. [PMID: 36618070 PMCID: PMC9812601 DOI: 10.1155/2022/4145872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/30/2022]
Abstract
Purpose A survival benefit of breast-conserving therapy (BCT) over mastectomy has been shown in recent studies. This study aimed to explore differences in recurrence patterns between BCT and mastectomy and clarify the contribution of radiotherapy (RT) to the survival benefit of BCT. Methods Consecutive patients with pT1-2/pN0-1/M0 breast cancer between 2009 and 2015 in our institution were retrospectively reviewed and compared in matched cohorts using 1 : 1 propensity score matching (PSM). Results A total of 2370 patients were enrolled with a median follow-up of 75 (3-148) months. In the cohort without regional nodal irradiation (RNI), WBI was associated with significantly increased 10-year relapse-free survival (RFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival (RRFS) compared with mastectomy alone. There were 419 pairs in the cohort without RNI and 87 pairs in the cohort with RNI after PSM. In the PSM cohort, improved 10-year RFS (95.4% vs. 82.7%, p < 0.05), DMFS (97.4% vs. 84.1%, p < 0.05), and RRFS (99.1% vs. 95.5%, p < 0.05) were observed in WBI compared with mastectomy alone. Regarding the first recurrence event, WBI demonstrated a significantly lower cumulative rate of distant metastases than mastectomy alone. There was no significant difference in survival outcomes between WBI plus RNI and PMRT before and after the PSM. In patients without RNI, mastectomy alone was significantly associated with unfavorable RFS (HR = 2.3, 95% CI 1.2-4.5, p < 0.05) and DMFS (HR = 2.5, 95% CI 1.1-5.8, p < 0.05). Conclusion This study found the benefit of RFS and DMFS in BCT patients compared with those treated with mastectomy without RNI but not in those treated with RNI. We hypothesized that RT played an important role in reducing the risk of regional recurrence and distant metastases.
Collapse
|
16
|
Shrestha P, Chu QD, Hsieh M, Yi Y, Peters ES, Trapido E, Yu Q, Ferguson T, Wu X. Distance to radiation therapy facility influences surgery type among older women with early‐stage breast cancer. Cancer Med 2022; 12:6842-6852. [PMID: 36495041 PMCID: PMC10067088 DOI: 10.1002/cam4.5474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/17/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breast-conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early-stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. METHODS Women diagnosed with stages 0-II breast cancer in 2013-2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio-demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. RESULTS Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5 miles to the nearest RTF, those with distance ≥40 miles or 15-40 miles had higher odds of mastectomy (adjusted (adj) OR = 1.39, 95% CI = 1.07-1.82; adj OR = 1.17, 95% CI = 1.02-1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI = 1.03-1.51) and 1.19 (95% CI = 1.04-1.35), respectively. Age-stratified analysis showed the significant association (p < 0.05) only presented among women aged ≥65, but not those aged <65 years. CONCLUSION Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed.
Collapse
Affiliation(s)
- Pratibha Shrestha
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Quyen D. Chu
- Orlando Health Cancer Institute Orlando Florida USA
| | - Mei‐Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Yong Yi
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Edward S. Peters
- Department of Epidemiology, UNMC College of Public Health Omaha Nebraska USA
| | - Edward Trapido
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Tekeda Ferguson
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| | - Xiao‐Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health at LSU Health Sciences Center‐New Orleans New Orleans Louisiana USA
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Zongo N, Ouédraogo S, Bado C, Kaboré A, Dem A. Survival of patients operated on for breast cancer in Ouagadougou/Burkina Faso. Eur J Surg Oncol 2022; 48:2378-2384. [PMID: 35871031 DOI: 10.1016/j.ejso.2022.07.001] [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: 04/02/2022] [Revised: 06/16/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Breast cancer is the most common cancer in women. The objective is to study the survival of patients operated on for breast cancer. METHODS Descriptive and analytical study of the survival of patients operated on for breast cancer between January 1, 2013 and December 31, 2020 in Ouagadougou. Survival was assessed by the Kaplan-Meier method and comparisons by the log-rank test. Prognostic factors were determined using the Cox model. RESULTS We collected 550 cases. Overall survival at 5 years was 66.2%. Those under 30 years of age had a low 5-year overall survival (53%). The 5-year overall survival was poor in rural patients (63.5%), triple-negative patients (77.2%), HER2+ patients (50.5%) and stage IV patients (29.8%). In multivariate analysis, higher education (p < 0.001) and higher socioeconomic level (p < 0.001) were associated with better prognoses. CONCLUSIONS The survival of patients operated on for breast cancer remains to be improved. It is influenced by multiple factors especially the socio-economic and educational level of the patients.
Collapse
Affiliation(s)
- Nayi Zongo
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso.
| | - Smaila Ouédraogo
- Public Health Department, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Chantal Bado
- Digestive and General Surgery, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Ahmed Kaboré
- Public Health Department, Yalgado Ouedraogo Teaching Hospital Ouagadougou, 03 BP 7021, Ouagadougou, Joseph Ki-Zerbo University, Burkina Faso
| | - Ahmadou Dem
- Institut Joliot Curie de Dakar (Sénégal), Cheikh Anta Diop University of Dakar, 10700, Dakar, Senegal
| |
Collapse
|
19
|
Zaher HAE, Fathy H, Abozeid M, faisal M. Neoadjuvant Chemotherapy for Stage II–III Breast Cancer: A Single-center Experience.. [DOI: 10.21203/rs.3.rs-968632/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Introduction
We conducted this study to reflect a single-center experience with the use of neoadjuvant systemic chemotherapy for the management of women with operable breast cancer.
Methods
We conducted a retrospective chart review on all women presenting with operable, stage II-III, breast cancer and were scheduled for neoadjuvant systemic chemotherapy at Suez Canal University Hospital. The primary outcome of this study was to estimate the proportion of patients with operable breast cancer who become eligible for breast conservative surgery (CBS) after neoadjuvant systemic chemotherapy.
Results
A total of 147 patients were included. Before the initiation of chemotherapy, only 66 (44.9%) patients were indicated for breast conservative surgery (CBS). A total of 40 (50.6%) new patients, out of the 81 patients who were ineligible before chemotherapy, became eligible for breast conservative surgery after neoadjuvant chemotherapy (95% CI 39.3–61.9%). On the other hand, eight (12.1%) patients became ineligible for breast conservative surgery after neoadjuvant chemotherapy. Out of the 98 eligible patients for breast conservative surgery after chemotherapy, 72 (73.5%) patients underwent the surgery, and the remaining 26 patients chose total modified radical mastectomy (MRM). A total of 55 (76.4%) patients achieved pathological complete response (pCR). One woman (0.1%) experienced relapse at the 3rd year of follow-up and three women (2%) experienced relapse at the 5th year of follow-up. The difference between patients who underwent breast conservative surgery and total mastectomy was not statistically significant (p = 0.22 and 0.07, respectively).
Conclusion
Neoadjuvant chemotherapy can play a crucial role in increasing the rate of eligibility for breast conservative surgery among women with operable, stage II-III, breast cancer.
Collapse
|
20
|
Orozco JIJ, Keller JK, Chang SC, Fancher CE, Grumley JG. Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery. Ann Surg Oncol 2022; 29:6299-6310. [PMID: 35896922 DOI: 10.1245/s10434-022-12190-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Randomized, controlled trials comparing breast-conserving therapy (BCT) with mastectomy have demonstrated equivalent overall survival (OS), but recent observational studies have shown improved OS in patients undergoing BCT. These studies provide limited data on young patients who are traditionally offered mastectomy due to perceived higher disease risk. This study examines the OS in a contemporary series of young women with breast cancer undergoing upfront BCT compared with mastectomy. METHODS Women ≤40 years old with primary invasive T1-T2, N0-N1 breast cancer were identified from the National Cancer Database between 2006 and 2016. Patient cohorts were based according to locoregional treatment: BCT, mastectomy alone (Mx), and mastectomy with radiotherapy (Mx/RT). Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) were performed to account for treatment selection bias effects in OS. RESULTS A total of 15,611 patients met the study criteria; 9,509 patients (60.9%) had BCT, 4,020 (25.8%) had Mx/RT, and 2,082 (13.3%) had Mx alone. The median follow-up was 4.6 years (interquartile range [IQR] 3.0-6.4). After IPTW-adjustment, the 5-year OS was similar for BCT (95%), Mx (95%), and Mx/RT (94%), and there was no significant difference in OS in Mx (hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.90-1.51) and Mx/RT (HR = 1.08, 95% CI 0.88-1.34) compared with BCT. Mx/RT was associated with decreased survival in patients with pT2N0 (HR = 1.78, 95% CI 1.12-2.84). CONCLUSIONS Among young patients with early-stage breast cancer, overall survival was equivalent regardless of surgical approach. Breast-conserving therapy remains a safe option in young women despite the clinical tendency to offer upfront mastectomy in young patients.
Collapse
Affiliation(s)
- Javier I J Orozco
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Jennifer K Keller
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Saint Joseph Health, Portland, OR, USA
| | - Crystal E Fancher
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Janie G Grumley
- Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.
| |
Collapse
|
21
|
De la Cruz Ku G, Karamchandani M, Chambergo-Michilot D, Narvaez-Rojas AR, Jonczyk M, Príncipe-Meneses FS, Posawatz D, Nardello S, Chatterjee A. Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients. Ann Surg Oncol 2022; 29:6163-6188. [PMID: 35876923 DOI: 10.1245/s10434-022-12133-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND There have been conflicting studies reporting on survival advantages between breast-conserving surgery with radiotherapy (BCS) in comparison with mastectomy. Our aim was to compare the efficacy of BCS and mastectomy in terms of overall survival (OS) comparing all past published studies. METHODS We performed a comprehensive review of literature through October 2021 in PubMed, Scopus, and EMBASE. The studies included were randomized controlled trials (RCTs) and cohorts that compare BCS versus mastectomy. We excluded studies that included male sex, stage 0, distant metastasis at diagnosis, bilateral synchronous cancer, neoadjuvant radiation/chemotherapy, and articles with incomplete data. We performed a meta-analysis following the random-effect model with the inverse variance method. RESULTS From 18,997 publications, a total of 30 studies were included in the final analysis: 6 studies were randomized trials, and 24 were retrospective cohorts. A total of 1,802,128 patients with a follow-up ranging from 4 to 20 years were included, and 1,075,563 and 744,565 underwent BCS and mastectomy, respectively. Among the population, BCS is associated with improved OS compared with mastectomy [relative risk (RR) 0.64, 95% confidence interval (CI) 0.55-0.74]. This effect was similar when analysis was performed in cohorts and multi-institutional databases (RR 0.57, 95% CI 0.49-0.67). Furthermore, the benefit of BCS was stronger in patients who had less than 10 years of follow-up (RR 0.54, 95% CI 0.46-0.64). CONCLUSIONS Patients who underwent BCS had better OS compared with mastectomy. Such results depicting survival advantage, especially using such a large sample of patients, may need to be included in the shared surgical decision making when discussing breast cancer treatment with patients.
Collapse
Affiliation(s)
- Gabriel De la Cruz Ku
- Department of General Surgery, University of Massachusetts, Worcester, MA, USA.,Universidad Científica del Sur, Lima, Peru
| | | | | | | | | | | | - David Posawatz
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Abhishek Chatterjee
- Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA. .,Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
22
|
Chien JC, Liu WS, Huang WT, Shih LC, Liu WC, Chen YC, Chou KJ, Shiue YL, Lin PC. Local treatment options for young women with ductal carcinoma in situ: A systematic review and meta-analysis comparing breast conserving surgery with or without adjuvant radiotherapy, and mastectomy. Breast 2022; 63:29-36. [PMID: 35299032 PMCID: PMC8927828 DOI: 10.1016/j.breast.2022.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 10/29/2022] Open
|
23
|
Chu QD, Hsieh MC, Yi Y, Lyons JM, Wu XC. Outcomes of Breast-Conserving Surgery Plus Radiation vs Mastectomy for All Subtypes of Early-Stage Breast Cancer: Analysis of More Than 200,000 Women. J Am Coll Surg 2022; 234:450-464. [PMID: 35290264 DOI: 10.1097/xcs.0000000000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent large retrospective studies suggest that breast-conserving therapy (BCT) plus radiation yielded better outcomes than mastectomy (MST) for women with early-stage breast cancer (ESBC). Whether this is applicable to the different subtypes is unknown. We hypothesize that BCT yielded better outcomes than MST, regardless of subtypes of ESBC. STUDY DESIGN Data on women diagnosed with first primary stage I to II breast cancer between 2010 and 2017 who underwent either BCT or MST were from the population-based 18 Surveillance, Epidemiology, and End Results cancer registries. The Kaplan-Meier method was used to estimate unadjusted 5-year overall survival and cause-specific survival. Univariable and multivariable Cox proportional regression models were used to determine the impact of surgical approaches on the hazard ratios adjusted for relevant demographic and clinical variables for molecular subtype (luminal A, luminal B, triple-negative, and HER2 enriched). RESULTS Of the 214,128 patients with breast cancer, 41.6% received MST. For the different subtypes, BCT yielded better 5-year overall survival and cause-specific survival than MST. After adjusting for demographic and clinical factors, the risk of overall survival and cause-specific survival was still statistically significantly higher among MST recipients than BCT recipients for all subtypes. CONCLUSIONS BCT yielded better survival rates than mastectomy for women with all subtypes of ESBC. The role of mastectomy for women with ESBC should be reassessed in future clinical trials.
Collapse
Affiliation(s)
- Quyen D Chu
- From the Departments of Surgery at LSU Health Sciences Center-Shreveport, Louisiana (Chu)
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
| | - Yong Yi
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
| | - John M Lyons
- Our Lady of the Lake-Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana (Lyons)
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
| |
Collapse
|
24
|
Li X, Sanz J, Argudo N, Vernet-Tomas M, Rodríguez N, Torrent L, Fernández-Velilla E, Pera O, Huang Y, Nicolau P, Jiménez M, Segura M, Algara M. Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation. Clin Transl Oncol 2021; 24:829-835. [PMID: 34792725 PMCID: PMC9013337 DOI: 10.1007/s12094-021-02728-0] [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: 08/03/2021] [Accepted: 10/30/2021] [Indexed: 12/03/2022]
Abstract
Purpose To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. Materials and methods Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. Results Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. Conclusion IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.
Collapse
Affiliation(s)
- X Li
- Autonomous University of Barcelona, Barcelona, Spain
| | - J Sanz
- Pompeu Fabra University, Barcelona, Spain. .,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano-2, 08003, Barcelona, Spain. .,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica (IMIM), Barcelona, Spain.
| | - N Argudo
- Breast Unit, Hospital del Mar, Barcelona, Spain
| | | | - N Rodríguez
- Pompeu Fabra University, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano-2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica (IMIM), Barcelona, Spain
| | - L Torrent
- Breast Unit, Hospital del Mar, Barcelona, Spain
| | - E Fernández-Velilla
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano-2, 08003, Barcelona, Spain
| | - O Pera
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano-2, 08003, Barcelona, Spain
| | - Y Huang
- Autonomous University of Barcelona, Barcelona, Spain
| | - P Nicolau
- Breast Unit, Hospital del Mar, Barcelona, Spain
| | - M Jiménez
- Breast Unit, Hospital del Mar, Barcelona, Spain
| | - M Segura
- Breast Unit, Hospital del Mar, Barcelona, Spain
| | - M Algara
- Autonomous University of Barcelona, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano-2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica (IMIM), Barcelona, Spain
| |
Collapse
|
25
|
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.
Collapse
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.
| |
Collapse
|
26
|
Ratosa I, Plavc G, Pislar N, Zagar T, Perhavec A, Franco P. Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer. Cancers (Basel) 2021; 13:cancers13164044. [PMID: 34439197 PMCID: PMC8393026 DOI: 10.3390/cancers13164044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The majority of patients with breast cancer are suitable for either breast-conserving therapy, consisting of breast-conserving surgery and radiation therapy, or mastectomy alone. In the present study, we compared survival outcomes in 1360 patients affected with early-stage breast cancer (stage I-IIA) according to the type of local treatment. We confirmed that patients treated with breast-conserving therapy had a lower rate of local, regional, and distant disease recurrences, and at least equivalent overall survival compared to those treated with mastectomy alone. Our results add to previous research showing a potential benefit of breast-conserving therapy when compared to mastectomy in patients suitable for both treatments at baseline. Abstract In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.
Collapse
Affiliation(s)
- Ivica Ratosa
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (I.R.); (G.P.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gaber Plavc
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (I.R.); (G.P.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Nina Pislar
- Department of Surgery, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tina Zagar
- Department of Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Andraz Perhavec
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Surgery, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia;
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Radiation Oncology Unit, AOU “Maggiore della Carità”, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3733725
| |
Collapse
|
27
|
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]
|
28
|
Parzen JS, Almahariq MF, Quinn TJ, Siddiqui ZA, Thompson AB, Guerrero T, Lee K, Stevens C, Grills IS. Higher biologically effective dose is associated with improved survival in patients with squamous cell carcinoma of the lung treated with stereotactic body radiation therapy. Radiother Oncol 2021; 160:25-31. [PMID: 33892021 DOI: 10.1016/j.radonc.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple studies have suggested that patients with early-stage SCC of the lung treated with SBRT are more susceptible to local failure compared to other NSCLC histologies. It is unknown if higher BED leads to improved outcomes in this patient population. We evaluated the effect of "high" BED versus "low" BED SBRT on overall survival (OS) in SCC and non-SCC NSCLC patients. METHODS The National Cancer Database was used to identify patients with cT1-2N0M0 NSCLC diagnosed between 2006-2016 treated with 3-5 fraction SBRT. Patients were grouped by BEDhigh (>150 Gy) and BEDlow (≤132 Gy). Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment (IPTW) weighting was used to account for selection bias. RESULTS We identified 4,717 eligible SCC patients and 8,807 eligible non-SCC NSCLC patients. In SCC patients, BEDhigh was associated with improved OS in both univariate and multivariate analysis (MVA HR 0.84 95% CI 0.76-0.92, p < 0.001), with estimated IPTW-adjusted 3-year OS of 49% compared to 41% for the BEDlow group. In contrast, BEDhigh was not associated with improved OS compared to BEDlow for non-SCC NSCLC patients (MVA HR 0.94 95% CI 0.86-1.04, p = 0.23), with estimated IPTW-adjusted 3-year OS of 54% and 53%, respectively. CONCLUSIONS Our analysis suggests that in patients with early-stage NSCLC, SBRT regimens with BED > 150 Gy may confer a survival benefit in patients with SCC histology. Histology-based dose modification should be considered, and prospective validation may be warranted.
Collapse
Affiliation(s)
- Jacob S Parzen
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Muayad F Almahariq
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States.
| | - Thomas J Quinn
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Zaid A Siddiqui
- University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Andrew B Thompson
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Thomas Guerrero
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Kuei Lee
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Craig Stevens
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Inga S Grills
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| |
Collapse
|
29
|
Li X, Sanz J, Foro P, Martínez A, Zhao M, Reig A, Liu F, Huang Y, Membrive I, Algara M, Rodríguez N. Long-term results of a randomized partial irradiation trial compared to whole breast irradiation in the early stage and low-risk breast cancer patients after conservative surgery. Clin Transl Oncol 2021; 23:2127-2132. [PMID: 33880724 DOI: 10.1007/s12094-021-02618-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis. METHODS AND MATERIALS WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system. RESULTS After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24). CONCLUSION After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.
Collapse
Affiliation(s)
- X Li
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Sanz
- Universitat Pompeu Fabra, Barcelona, Spain. .,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain. .,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain.
| | - P Foro
- Universitat Pompeu Fabra, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain
| | - A Martínez
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain
| | - M Zhao
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Reig
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain
| | - F Liu
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain
| | - Y Huang
- Universidad Autónoma de Barcelona, Barcelona, Spain
| | - I Membrive
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain
| | - M Algara
- Universidad Autónoma de Barcelona, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain
| | - N Rodríguez
- Universitat Pompeu Fabra, Barcelona, Spain.,Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, C/. Del Gas s/n Edificio B, sótano -2, 08003, Barcelona, Spain.,Radiation Oncology Research Group, Institut Municipal d'InvestigacióMédica IMIM, Barcelona, Spain
| |
Collapse
|
30
|
Laas E, Bresset A, Féron JG, Le Gal C, Darrigues L, Coussy F, Grandal B, Laot L, Pierga JY, Reyal F, Hamy AS. HER2-Positive Breast Cancer Patients with Pre-Treatment Axillary Involvement or Postmenopausal Status Benefit from Neoadjuvant Rather than Adjuvant Chemotherapy Plus Trastuzumab Regimens. Cancers (Basel) 2021; 13:370. [PMID: 33498405 PMCID: PMC7864202 DOI: 10.3390/cancers13030370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND No survival benefit has yet been demonstrated for neoadjuvant chemotherapy (NAC) against HER2-positive tumors in patients with early breast cancer (BC). The objective of this study was to compare the prognosis of HER2-positive BC patients treated with NAC to that of patients treated with adjuvant chemotherapy (AC). MATERIALS AND METHODS We retrospectively analyzed disease-free (DFS) and overall survival (OS) in 202 HER2-positive patients treated with NAC and 701 patients treated with AC. All patients received trastuzumab in addition to chemotherapy. Patient data were weighted by a propensity score to overcome selection bias. RESULTS After inverse probability of treatment weights (IPTW) adjustment, no difference in DFS (p = 0.3) was found between treatments for the total population. However, after multivariate analysis, an interaction was found between cN status and chemotherapy strategy (IPTW-corrected corrected Hazard ratio cHR = 0.52, 95% CI (0.3-0.9), p interaction = 0.08) and between menopausal status and chemotherapy (CT) strategy (cHR = 0.35, 95%CI (0.18-0.7)) p interaction < 0.01). NAC was more beneficial than AC strategy in cN-positive patients and in postmenopausal patients. Moreover, after IPTW adjustment, the multivariate analysis showed that the neoadjuvant strategy conferred a significant OS benefit (cHR = 0.09, 95%CI [0.02-0.35], p < 0.001). CONCLUSION In patients with HER2-positive BC, the NAC strategy is more beneficial than the AC strategy, particularly in cN-positive and postmenopausal patients. NAC should be used as a first-line treatment for HER2-positive tumors.
Collapse
Affiliation(s)
- Enora Laas
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Arnaud Bresset
- Gynecology Department, Beaujon Hospital, 92210 Clichy, France;
| | - Jean-Guillaume Féron
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Claire Le Gal
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Lauren Darrigues
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
| | - Lucie Laot
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Fabien Reyal
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
| |
Collapse
|
31
|
Six-year experience of oncoplastic volume replacement using local perforator flaps. J Plast Reconstr Aesthet Surg 2021; 74:2184-2193. [PMID: 33531208 DOI: 10.1016/j.bjps.2020.12.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/02/2020] [Accepted: 12/20/2020] [Indexed: 12/27/2022]
Abstract
Local perforator flaps may be utilised to correct volume defects after breast-conserving surgery (BCS), improving the cosmetic outcome and avoiding the need for contralateral symmetrising surgery. The aims of this study were to assess longer term oncological outcomes following local perforator flap reconstruction, and to demonstrate the learning curve associated with incorporating such techniques within routine clinical practice. We report a consecutive case series of 116 local perforator flaps performed between January 2014 and May 2020. Data collected included patient demographics, tumour characteristics, surgical procedure data, complications and follow-up outcomes. All breast cancer patients are followed with annual mammographic surveillance for a minimum of five years. Of 116 procedures, 101 were performed as immediate partial breast reconstruction and 15 as delayed reconstructive procedures for patients who had prior breast surgery. The overall complication rate was 15%; the majority were minor surgical site infections, 1.7% required haematoma evacuation. At a median follow-up of 37 months, there were no local cancer recurrences. Three patients who underwent delayed reconstruction required revision procedures, and one required a contralateral symmetrisation procedure. One patient in the immediate reconstruction group required additional lipofilling. Over time, the mean lesion size selected for immediate local flap reconstruction increased, operative times decreased and the proportion of day case procedures increased. Our data confirm that local perforator flaps are associated with low morbidity, excellent oncological outcomes and long-term durability. The use of local flaps can increase the range of indications for BCS, reducing mastectomy rates and the associated revision and symmetrising procedures associated with them.
Collapse
|
32
|
Liu R, Xiao Z, Hu D, Luo H, Yin G, Feng Y, Min Y. Cancer-Specific Survival Outcome in Early-Stage Young Breast Cancer: Evidence From the SEER Database Analysis. Front Endocrinol (Lausanne) 2021; 12:811878. [PMID: 35116010 PMCID: PMC8805172 DOI: 10.3389/fendo.2021.811878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Young women with breast cancer are determined to present poorer survival compare with elderly patients. Therefore, identifying the clinical prognostic factors in young women with early-stage (T1-2N0-1M0) breast cancer is pivotal for surgeons to make better postoperative management. METHODS The clinicopathological characteristics of female patients with early-stage breast cancer from the Surveillance, Epidemiology, and End Results program between Jan 2010 and Dec 2015 were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival in young women with early-stage breast cancer. The nomogram was constructed and further evaluated by an internal validation cohort. The Kaplan-Meier survival curves were used to estimate cancer-specific survival probability and the cumulative incidence. RESULTS Six variables including race, tumor location, grade, regional lymph node status, tumor subtype, and size were identified to be significantly associated with the prognosis of young women with early-stage breast cancer during the postoperative follow-up. A nomogram for predicting the 3-, 5- year cancer-specific survival probability in this subpopulation group was established with a favorable concordance index of 0.783, supported by an internal validation cohort with the AUC of 0.722 and 0.696 in 3-, 5- year cancer-specific survival probability, respectively. CONCLUSIONS The first predictive nomogram containing favorable discrimination is successfully established and validated for predicting the 3-, 5- year cancer-specific survival probability in young women with early-stage breast cancer during the postoperative follow-up. This model would help clinicians to make accurate treatment decisions in different clinical risk population.
Collapse
Affiliation(s)
- Rui Liu
- Department of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhesi Xiao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haojun Luo
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yu Min, ; Yang Feng,
| | - Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yu Min, ; Yang Feng,
| |
Collapse
|
33
|
Chu QD, Hsieh MC, Lyons JM, Wu XC. 10-Year Survival after Breast-Conserving Surgery Compared with Mastectomy in Louisiana Women with Early-Stage Breast Cancer: A Population-Based Study. J Am Coll Surg 2020; 232:607-621. [PMID: 33301909 DOI: 10.1016/j.jamcollsurg.2020.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Louisiana has the third highest breast cancer mortality in the US, despite ranking 30th in incidence. Whether surgical approach contributes to such a poor outcome is unknown. We compared outcomes of breast-conserving surgery plus radiation (BCT) vs mastectomy (MST) for Louisiana women with early-stage breast cancer. STUDY DESIGN Data on women diagnosed with Stage I-II breast cancer from 2004 to 2016 were analyzed from the Louisiana Tumor Registry. Overall survival (OS) and breast cancer-specific survival (CSS) were compared between BCT and MST. Kaplan-Meier method and log-rank test were used to compare survival curves, and logistic regression was used to examine the association of sociodemographic and clinical factors with the type of breast cancer surgery. Values of p < 0.05 were considered significant. RESULTS Of the 18,260 patients, 9,968 patients (54.6%) had BCT and 8,292 patients (45.4%) had MST. Compared with BCT, the MST group tended to be underinsured/Medicare/Medicaid, more impoverished, had higher stage 2 disease, were more likely to reside in rural regions, travel ≥25 miles to radiation treatment facility, be treated at low volume centers, and have T3, node positive, and poorly differentiated tumors. Ten-year OS and CSS were significantly better among those who had BCT (OS: 80.0%; 95% CI: 79.0%-81.1%; CSS: 92.7%; 95% CI: 92.1%-93.4%) than those having MST (OS: 69.3%; 95% CI: 68.0%-70.5%; CSS: 88.8%:95% CI: 87.9%-89.7%) (p < 0.05). Even after controlling for sociodemographic and clinical variables, MST was associated with a 28.6% increased risk of death from all causes (hazard ratio [HR]:1.286; 95% CI:1.197-1.380) and a 29.8% increased risk of breast-cancer specific death (HR:1.298; 95% CI: 1.150-1.465). CONCLUSIONS Surgical approach, a factor that is within the control of the surgeon, has an impact on mortality for Louisiana women with early-stage breast cancer.
Collapse
Affiliation(s)
- Quyen D Chu
- Department of Surgery, LSU Health Sciences Center, Shreveport, LA.
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center, New Orleans, LA
| | - John M Lyons
- Our Lady of the Lake-Mary Bird Perkins Cancer Center, Baton Rouge, LA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center, New Orleans, LA
| |
Collapse
|
34
|
Quinn TJ, Kabolizadeh P. Rectal cancer in young patients: incidence and outcome disparities. J Gastrointest Oncol 2020; 11:880-893. [PMID: 33209484 DOI: 10.21037/jgo-20-197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background There is an alarming rise in incidence among young patients with rectal cancer. The National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Analysis (SEER) databases may help identify population level disparities in incidence and cancer-related outcomes. Methods A total of 197,178 patients within the SEER 18 registry and 221,886 patients from the NCDB database with rectal cancer were evaluated in this retrospective cohort study. The analyzed cohort consisted of young (<50), white or African American patients. Indication bias was mitigated by conducting inverse probability of treatment weighted analysis using binary logistic regression modeling to determine propensity score for being white or African American. Results A total of 6,144 young patients were identified from the SEER 18 registry and a total of 17,819 young patients were identified from the NCDB. From 1990 to 2016, there was a significant change in rectal cancer incidence, with a steadily increasing APC of 3.06 (P<0.05). The was no overall change in age-adjusted APC among young African American patients (APC 0.00, P=1); however, there was a significant increase among young white patients (APC 2.97, P<0.05). There was an increased incidence for both stage III and IV among young rectal cancer patients, with an age-adjusted APC of 5.35 and 3.83, respectively (P<0.05). After propensity score matching and inverse probability of treatment weighting, young African Americans had worse overall survival in both the NCDB and SEER (HR 1.1-1.3, P<0.05) databases. This disparity was also seen for cancer-specific survival (HR 1.5, P=0.002). Conclusions The current study adds to the growing body of literature demonstrating an alarming increase in incidence of rectal cancer among young patients. Moreover, the incidence appears to be increasing particularly among young white patients and driven by stage III disease.
Collapse
Affiliation(s)
- Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | | |
Collapse
|