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Qin R, Yin L, Wang D, Cao X, Shaibu Z, Wang X, Chen P, Sui D, Qiu X, Liu D. Survival Outcomes of Breast-Conserving Surgery Versus Mastectomy in Locally Advanced Breast Cancer Following Neoadjuvant Chemotherapy: A Meta-Analysis. Technol Cancer Res Treat 2024; 23:15330338241265030. [PMID: 39043051 PMCID: PMC11271104 DOI: 10.1177/15330338241265030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/03/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Mastectomy (MT) and breast conservation surgery (BCS) are two common surgical options for the treatment of locally advanced breast cancer (LABC). Neoadjuvant chemotherapy (NACT) is frequently administered before surgery to shrink tumors and improve surgical outcomes. However, there is a lack of consensus on the optimal surgical approach after NACT and its impact on survival outcomes. OBJECTIVE This meta-analysis aims to compare the survival outcomes between MT and BCS in patients treated with NACT. METHOD A PRISMA selection was used to identify studies across electronic database such as PubMed, and Cochrane Library from inception until 11th July, 2023. A total of 10 comparative studies involving a total of 5018 patients were included. Among them, 2898 patients underwent MT while 2120 underwent BCS after receiving NACT. The outcomes assessed were the 5-year overall survival (OS) and 5-year disease-free survival (DFS). The data from the included studies were pooled, and odds ratios (OR) with 95% confidence intervals (CI) were calculated to evaluate the differences between MT and BCS in terms of survival outcomes. Prospero: CRD42024496831. RESULT The meta-analysis revealed that patients who underwent MT after NACT had a higher 5-year OS compared to those who underwent BCS (OR 2.68, 95% CI [2.19-3.28; p < 0.00001]). Additionally, the 5-year DFS was significantly better for patients who underwent MT (OR 3.11, 95% CI [1.80-5.38; p < 0.0001]). CONCLUSION MT after NACT may be associated with better 5-year OS and DFS compared to BCS.
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Affiliation(s)
- Rong Qin
- Department of Medical Oncology, Jiangsu University Affiliated People's Hospital, Zhenjiang Clinical Medical College of Nanjing Medical University, Zhenjiang, China
| | - Liang Yin
- Department of Breast Surgery, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Deqian Wang
- Department of Breast Surgery, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Xuan Cao
- Department of Breast Surgery, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Zakari Shaibu
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiangyang Wang
- Department of Traditional Chinese Medicine, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Peiqin Chen
- Department of Breast Surgery, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Danjuan Sui
- Department of Pharmacy, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Xiaoxi Qiu
- Department of Breast Surgery, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Dan Liu
- Nursing Department, Heyang County People's Hospital, Weinan City, Shaanxi Province, China
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Nobrega GB, Mota BS, de Freitas GB, Maesaka JY, Mota RMS, Goncalves R, Trinconi AF, Ricci MD, Piato JR, Soares-Jr JM, Baracat EC, Filassi JR. Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment. Front Oncol 2023; 13:1293288. [PMID: 38023121 PMCID: PMC10657840 DOI: 10.3389/fonc.2023.1293288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain. Methods We conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs). Results Among the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069-2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006-1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561-3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220-0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177-0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347-1.383). Conclusion Our findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes.
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Affiliation(s)
- Gabriela Bezerra Nobrega
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruna Salani Mota
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela Boufelli de Freitas
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jonathan Yugo Maesaka
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Rodrigo Goncalves
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Angela Francisca Trinconi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Desidério Ricci
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Piato
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Maria Soares-Jr
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Ranganath R, Hui M, Uppin S, Jena S, Shantappa R. An Audit of Breast Conservation Surgery for Breast Cancer - a 7-Year Experience from Southern India. Indian J Surg Oncol 2023; 14:492-496. [PMID: 37324291 PMCID: PMC10267059 DOI: 10.1007/s13193-022-01532-8] [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: 07/03/2021] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
To audit the use of breast conservation surgery for breast cancer treatment in a tertiary care centre over a 7-year period, and also to chart the clinical, demographic and pathological characteristics of breast cancer patients treated in the setting of a referral centre in a middle income (MDI) group country. A retrospective analysis of the case records of all patients of invasive breast cancer treated at our institute between January 2014 and December 2020 was done after obtaining approval from the Institute Ethics Committee (IEC). The number of patients seen, age, parity, menopausal status, family history of cancer, laterality, site of tumour in the breast, the symptomatology, clinical stage and presence or absence of metastases was the clinical parameters examined. The pathological stage and grade of the tumour, receptor status, treatment offered according to stage and the patterns of failure with respect to the surgery performed were recorded. Statistical analysis was a direct head to head comparison of the percentage proportions of the different variables. A total of 685 patients of breast cancer were treated between January 2014 and December 2020. A total of 53% of the cohort was more than 45 years old and 56.7% were post menopausal. A total of 58.8% of the patients presented with a cancer in the left breast and in the upper outer quadrant. Nearly 41% of the tumours were more than 4 cm in size. The most common receptor profile in our patient population was ER positive, PR positive and HER 2 negative. A total of 27.7% of the patients were offered neo-adjuvant chemotherapy and 63.06% underwent upfront surgery. A total of 19.7% of all surgeries performed (overall) were breast conservation surgeries (BCS). The use of BCS showed an increasing trend over the 7 years studied rising from 16.79 to 25% (annually). The local failure rate for BCS was 11.8% but the incidence of distant metastases was not significantly different compared to the patients who underwent a mastectomy. Breast conservation is safe and feasible in a referral setting even in a middle income nation with multi-disciplinary treatment planning and needs to be adopted widely to preserve the body image and self esteem of patients with breast cancer.
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Affiliation(s)
- R. Ranganath
- Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, TG India
| | - Monalisa Hui
- Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, TG India
| | - Shantveer Uppin
- Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, TG India
| | - S. Jena
- Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, TG India
| | - Rajshekar Shantappa
- Department of Surgical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, TG India
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Omari M, Zarrouq B, Amaadour L, Benbrahim Z, El Asri A, Mellas N, El Rhazi K, Ragala MEA, Halim K. Psychological Distress, Coping Strategies, and Quality of Life in Breast Cancer Patients Under Neoadjuvant Therapy: Protocol of a Systematic Review. Cancer Control 2022; 29:10732748221074735. [PMID: 35191730 PMCID: PMC8874168 DOI: 10.1177/10732748221074735] [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] [Indexed: 12/24/2022] Open
Abstract
Introduction Women with breast cancer eligible for neoadjuvant therapy (NAT) present a disorder of biopsychosocial variables and alteration of their quality of life. They cope with this changing by adopting psychological adjustment strategies, either passive or active. This systematic review aims to investigate the psychological distress, coping strategies, and quality of life in breast cancer patients under neoadjuvant therapy. Methods Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Wiley Online library represent the databases that were searched to identify relevant published articles until September 27, 2021. Full-text published articles, written in English and assessing the main outcomes (namely: psychological distress, coping strategies, and quality of life) in women with breast cancer under NAT will be included. Also, we will integrate papers dealing with the related bio psychosocial variables to the main variables. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. We will bring together the results of all of the included studies to draw conclusions based on the body of evidence. The narrative approach will be adopted to analyze the results and conclusions extracted and we would perform quantitative groupings if we have similar data. Ethics and dissemination Ethical approval is not required as the proposed systematic review will not use primary data. The results of this review will be disseminated through publication in a peer-reviewed journal and conference presentation(s). PROSPERO registration number: CRD42021230300.
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Affiliation(s)
- Majid Omari
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, 314397Sidi Mohammed Ben Abdallah University, Fez, Morocco.,Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, 243338Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Department of nursing care and health techniques, oncology hospital107907, Hassan II University Hospital, Fez, Morocco
| | - Btissame Zarrouq
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, 314397Sidi Mohammed Ben Abdallah University, Fez, Morocco.,Teacher's Training College (Ecole Normale Supérieure), Department of Biology and Geology, 107907Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Lamiae Amaadour
- Department of Medical Oncology, 470521Hassan II University Hospital, Fez, Morocco
| | - Zineb Benbrahim
- Department of Medical Oncology, 470521Hassan II University Hospital, Fez, Morocco
| | - Achraf El Asri
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, 314397Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Nawfel Mellas
- Department of Medical Oncology, 470521Hassan II University Hospital, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, 314397Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Mohammed El Amine Ragala
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, 243338Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Teacher's Training College (Ecole Normale Supérieure), Department of Biology and Geology, 107907Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Karima Halim
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, 243338Sidi Mohamed Ben Abdellah University, Fez, Morocco.,Teachers Training College (Ecole Normale Superieure), Department of Human and Social Sciences - Education Sciences, 314397Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Traore B, Keita M, Toure A, Camara I, Barry A, Koulibaly M. Impact of surgery associated with radiotherapy on the prognosis of breast cancer - Guinea Breast Cancer Cohort Study. Cancer Rep (Hoboken) 2021; 5:e1554. [PMID: 34549551 PMCID: PMC9458488 DOI: 10.1002/cnr2.1554] [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: 10/12/2020] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background In a country where radiotherapy (RT) is not available, advocacy based on the relevance of surgery + adjuvant RT in locoregional control and survival is needed. Aim To evaluate the impact of surgery with RT on local control and survival compared to surgery alone in breast cancer (BC). Methods and results Between 2007 and 2016, 210 patients with BC were retrospectively reviewed, of which 90 patients underwent surgery with RT (group 1) and 120 patients' surgery (group 2). There were several treatment combinations, including surgery combined with neoadjuvant chemotherapy [ACT], RT, and ACT. The results showed 88 (41.9%) cases of relapse, including 31 (34.4%) (group 1) and 57 (47.5%) (group 2) (p = .046). Recurrence occurred after a mean time of 1.5 years in group 1 versus 0.66 years in group 2 (p = .006). The 5‐year overall and BC‐specific survivals were 49.5% and 62.5%, respectively. The 5‐year survival was 60.0% (group 1) and 40.0% (group 2) (p < .05). In a multivariate analysis by Cox model, we found that the risk of death was 1.90 81 (95% CI [1.17 09–3.0701]) higher in group 2 (p = .009022), 1.69 85 (95% CI 1.00087–23.86157) in obese patients and decreased by 0.21 (95% CI [0.129–0.368]) in patients who did not relapse (p < .001). Conclusion In this study with several combination therapies, we cannot confirm that RT improves mainly locally advanced BC prognosis regardless of systemic treatment. However, we found that the risk of death correlated with the absence of RT, overweight, and risk of recurrence. Consideration of combinations of locoregional and systemic therapies, clinicopathological and biological data could improve the relevance of these results with a large sample size.
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Affiliation(s)
- Bangaly Traore
- Surgical Oncology Unit of Donka, Faculty of Health Sciences and Technics, University Gamal Abdel Nasser of Conakry, Guinea
| | - Mamady Keita
- Surgical Oncology Unit of Donka, Faculty of Health Sciences and Technics, University Gamal Abdel Nasser of Conakry, Guinea
| | - Abdoulaye Toure
- Epidemiology, Center for Research and Training in infectiology of Guinea (CERFIG), Guinea
| | - Ibrahima Camara
- Epidemiology, Center for Research and Training in infectiology of Guinea (CERFIG), Guinea
| | - Assiatou Barry
- Surgical Oncology Unit of Donka, Faculty of Health Sciences and Technics, University Gamal Abdel Nasser of Conakry, Guinea
| | - Moussa Koulibaly
- Laboratory of Pathology of Donka National Hospital, Faculty of Health Sciences and Technics, University Gamal Abdel Nasser of Conakry, Guinea
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Emiroglu M, Sert I, Karaali C, Aksoy SO, Ugurlu L, Aydın C. The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer. Breast Cancer 2015; 23:463-70. [DOI: 10.1007/s12282-015-0585-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/31/2014] [Indexed: 12/01/2022]
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Combination of high-intensity focused ultrasound with nanoscale ultrasound contrast agent in treatment of rabbit breast VX2 tumors: a pilot study. Clin Imaging 2012; 36:717-23. [DOI: 10.1016/j.clinimag.2012.01.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 01/31/2023]
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Breast cancer in low- and middle-income countries: an emerging and challenging epidemic. JOURNAL OF ONCOLOGY 2010; 2010:490631. [PMID: 21209708 PMCID: PMC3010663 DOI: 10.1155/2010/490631] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/13/2010] [Indexed: 11/22/2022]
Abstract
Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.
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Changing trends of breast cancer survival in sultanate of oman. JOURNAL OF ONCOLOGY 2010; 2011:316243. [PMID: 20981261 PMCID: PMC2964035 DOI: 10.1155/2011/316243] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/03/2010] [Accepted: 09/11/2010] [Indexed: 11/17/2022]
Abstract
Breast cancer is the leading cause of cancer-associated mortality in women, with elevated incidence in developing countries. This retrospective study included all 122 patients diagnosed with breast cancer from January 2003 to December 2008 in the Sultanate of Oman. Age at presentation was 47.41 years (SD±12.88), with one-third of patients younger than 40 years. The majority of patients presented with stage III (41.2%) and IV (18.2%) breast cancer. T size (P = .023), skin involvement (P = .003), and stage at presentation (P = .004) were significantly associated with overall survival. Skin involvement at presentation (P = .003), T size (P = .09), lymph node status (P = .013), and stage (P = .003) were strong predictors of relapse-free survival. Patients had a 5-year survival of 78%, compared to 64% of breast cancer patients diagnosed between 1996 and 2002 identified in our previously published study. Thus, despite Omani breast cancer patients continuing to present with advanced breast cancer, survival rates have significantly improved.
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