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Cheun JH, Chung S, Han JH, Lee YW, Jung JJ, Chun JW, Lee EG, Min JW, Kim Z, Lee J, Jung SY, Kim YS, Yu JH, Kim EK, Lee JW, Hwang KT, Kim KS, Youn HJ, Moon HG. Surveillance for Distant Metastasis in Breast Cancer Patients Who Underwent Contemporary Management: A Report from the Korean Breast Cancer Society Survivor Research Group. Ann Surg Oncol 2024:10.1245/s10434-024-15665-3. [PMID: 38969851 DOI: 10.1245/s10434-024-15665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Current guidelines recommend against the use of routine imaging tests to detect distant metastasis in asymptomatic breast cancer patients. However, recent advancements in effective therapeutics and diagnostic accuracy have raised the need to reassess the clinical efficacy of intensive metastasis surveillance. We report the results of a multicenter retrospective study to investigate the association between intensive imaging studies and survival outcomes. PATIENTS AND METHODS We retrospectively reviewed the data of 4130 patients who underwent surgery from 11 hospitals in Korea between January 2010 and December 2011. Patients were divided into two groups on the basis of the intensity of metastasis imaging studies during their disease-free period. The types and intervals of the imaging studies were based on each physician's decisions. RESULTS High-intensive screening showed a shorter distant metastasis-free survival [p < 0.001, hazard ratio (HR) 1.62; 95% confidence interval (CI) 1.29-2.04], especially for patients in whom bone or lung was the first site of metastasis. With a median follow-up period of 110.0 months, the 5-year breast cancer-specific survival (BCSS) rate was 96.5%. The high-intensity screening group showed significantly poorer BCSS compared with the low-intensity screening group (p < 0.001, HR 3.13; 95% CI 2.32-4.21). However, both multivariable analysis and propensity score matching analysis showed no significant association between the screening intensity and BCSS. CONCLUSIONS Frequent imaging studies to detect distant metastasis were associated with earlier detection of distant metastasis, especially for lung and bone metastasis. However, intensive surveillance showed no apparent association with BCSS despite the use of currently available treatments.
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Affiliation(s)
- Jong-Ho Cheun
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sooyeon Chung
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Jai Hong Han
- Center for Breast Cancer, National Cancer Center, Goyang, South Korea
| | - Young-Won Lee
- Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ji-Jung Jung
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Whan Chun
- Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Gyeong Lee
- Center for Breast Cancer, National Cancer Center, Goyang, South Korea
| | - Jun Won Min
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, South Korea
| | - Yoo Seok Kim
- Department of Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, South Korea
| | - Jong Han Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jong-Won Lee
- Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Ku Sang Kim
- Department of Surgery, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea.
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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Hwang YH, Yoo TK, Lee SB, Kim J, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH. Comparison of long-term oncological outcomes after central lumpectomy versus nipple-sparing breast-conserving surgery for centrally located breast cancer: a propensity score-matched study. Breast Cancer Res Treat 2024; 205:117-125. [PMID: 38332198 DOI: 10.1007/s10549-024-07267-0] [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: 10/17/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the oncological safety of nipple-sparing breast-conserving surgery (BCS) versus central lumpectomy for centrally located breast cancer (CLBC). METHODS Patients who underwent BCS for CLBC at Asan Medical Center from 2007 to 2018 were reviewed retrospectively. The oncological outcomes of nipple-sparing BCS (NS-BCS) and central lumpectomy were compared using univariate and multivariate Cox regression analyses and compared again after 1:1 propensity score matching (PSM). RESULTS The study included 306 patients who underwent NS-BCS and 106 patients who underwent central lumpectomy (median follow-up: 111 months). On multivariate analysis, central lumpectomy had a lower risk of local recurrence compared to NS-BCS, albeit without statistical significance (HR 0.14, 95% CI 0.02-1.24; p = 0.077). There was no significant difference in the risk of death (HR 0.14, 95% CI 0.01-1.68, p = 0.12). After PSM, each group had 106 patients. The 5-year and 10-year local recurrence-free survival rates were 94.2% and 92.9% for NS-BCS, and 99.1% and 99.1% for central lumpectomy, respectively (p = 0.031). There were no significant differences in overall survival, regional recurrence-free survival, or distant recurrence-free survival. Fifteen patients (4.9%) who underwent NS-BCS had ipsilateral breast tumor recurrence (IBTR), of which 40% were in the nipple-areolar complex and previous surgical sites. One patient (0.9%) who underwent central lumpectomy experienced an IBTR in a different quadrant. CONCLUSION NS-BCS showed more local recurrence than central lumpectomy. When deciding whether to spare the nipple during BCS in CLBC, patients should be sufficiently informed about the risk of IBTR.
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Affiliation(s)
- Yung-Huyn Hwang
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Tae-Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Setyawan IGB, Kurnia D, Setiaji K, Anwar SL, Purwanto DJ, Azhar Y, Budijitno S, Suprabawati DGA, Priyono SH, Siregar BA, Indriawan R, Tripriadi ES, Umar M, Pieter JSLA, Yarso KY, Hermansyah D, Wibisana IGNG, Harahap WA, Gautama W, Achmad D. Sociodemographic disparities associated with advanced stages and distant metastatic breast cancers at diagnosis in Indonesia: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:4211-4217. [PMID: 37663742 PMCID: PMC10473298 DOI: 10.1097/ms9.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background The global health burden of breast cancer is increasing with 5-year survival rates being much shorter in low-income and middle-income countries. Sociodemographic and clinical disparities in early cancer detection affect long-term outcome. Methods The authors compared social, demographic, and pathological characteristics associated with metastatic and late stages of breast cancer diagnosis using data collected from a special registry developed by Perhimpunan Bedah Onkologi Indonesia (PERABOI) in 2015. Results Of 4959 patients recruited in this study, 995 women (20.1%) were diagnosed with metastatic breast cancer. Lower education status and living in rural areas were significantly associated with Stage IV at diagnosis [odds ratio (OR)=1.256, 95% CI=1.093-1.445, P=0.001; and OR=1.197, 95% CI=1.042-1.377, P=0.012; respectively). Main complaints other than lump (ulceration, breast pain, and discharge) and occupation as a housewife were also associated with the presentation of metastatic diseases (OR=2.598, 95% CI=2.538-3.448, P<0.001 and OR=1.264, 95% CI=1.056-1.567, P=0.030, respectively). Having lower education and living outside Java and Bali islands were associated with the diagnosis of late-stage breast cancers (OR=1.908, 95% CI=1.629-2.232, P<0.001 and OR=3.039, 95% CI=2.238-4.126, P<0.001; respectively). A higher proportion of breast cancer patients were relatively younger with bigger tumour size, positive axillary nodal involvement, and more frequent Human epidermal growth factor receptor 2 overexpression. Conclusion The authors identified sociodemographic disparities in the metastatic and late-stage diagnosis of breast cancers among Indonesian women. The subsequent action is required to reduce disparities faced by women with lower social and educational levels for early diagnosis and better healthcare access.
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Affiliation(s)
- IG Budhi Setyawan
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr IGNG Ngoerah/Udayana University, Denpasar, Bali
| | - Dian Kurnia
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Dr M. Yunus Bengkulu, Kota Bengkulu, Bengkulu
| | - Kunta Setiaji
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Sardjito / Universitas Gadjah Mada, Yogyakarta
| | - Sumadi Lukman Anwar
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Sardjito / Universitas Gadjah Mada, Yogyakarta
| | - Deni J. Purwanto
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSK Dharmais, Jakarta 11420, DKI Jakarta
| | - Yohana Azhar
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Hasan Sadikin / Universitas Padjadjaran, Bandung, Jawa Barat
| | - Selamat Budijitno
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Kariadi / Universitas Diponegoro, Semarang, Jawa Tengah
| | - Desak Gede Agung Suprabawati
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Dr Soetomo / Universitas Airlangga, Surabaya, Jawa Timur
| | - Sasongko Hadi Priyono
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, Universitas Lambung Mangkurat, Banjarmasin, Kalimantan Selatan
| | - Bintang Abadi Siregar
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Dr H Abdul Moeloek / Universitas Lampung, Bandar Lampung, Lampung
| | - Ramses Indriawan
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Propinsi NTB / Universitas Mataram, Kota Mataram, Nusa Tenggara Barat
| | - Effif Syofra Tripriadi
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Dr Arifin Achmad / Universitas Riau, Pekanbaru, Riau
| | - Mulawan Umar
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Moh Hoesain / Universitas Sriwijaya, Palembang, Sumatra Selatan
| | - John SLA Pieter
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Wahidin Sudirohusodo / Universitas Hasanuddin, Makassar, Sulawesi Selatan
| | - Kristanto Yuli Yarso
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUD Dr Moewardi / Universitas Sebelas Maret, Surakarta, Jawa Tengah
| | - Dedy Hermansyah
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr H Adam Malik / Universitas Sumatra Utara, Medan, Sumatra Utara
| | - IGN Gunawan Wibisana
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Cipto Mangunkusumo / Universitas Indonesia, Padang, Sumatra Barat
| | - Wirsma Arif Harahap
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr M Djamil / Universitas Andalas, Jakarta, DKI Jakarta, Indonesia
| | - Walta Gautama
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSK Dharmais, Jakarta 11420, DKI Jakarta
| | - Dimyati Achmad
- Perhimpunan Bedah Onkologi Indonesia (PERABOI)/Indonesian Association of Surgical Oncology (ISSO)
- Division of Surgical Oncology, RSUP Dr Hasan Sadikin / Universitas Padjadjaran, Bandung, Jawa Barat
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