Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients

Article information

Kosin Med J. 2016;31(1):19-29
Publication date (electronic) : 2016 February 04
doi : https://doi.org/10.7180/kmj.2016.31.1.19
1Department of Surgery, Busan adventist Hospital, Busan, Korea
2Department of Surgery, College of Medicine, Kosin University, Busan, Korea
Corresponding Author: Chung Han Lee, Department of Surgery, Kosin University Gospel Hospital, 262, Gamcheon-ro, Seo-gu, Busan, 49267, Korea Tel: +82-51-990-6462 Fax: +82-51-246-6093 E-mail: mammomaster@naver.com
Received 2013 July 08; Revised 2013 October 21; Accepted 2013 October 26.

Abstract

Abstract

Objectives

Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM).

Methods

In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected.

Results

Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P< 0.01). However, there was no significant correlation between overall survival period and operative methods (P= 0.67). In addition, recurrence pattern (P= 0.21), recurrent rate (P= 0.36) and site (P= 0.45, P= 0.09) were not associated with operative method.

Conclusions

In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.

Fig. 1.

Disease free survival curves between MRM and BCS.

Fig. 2.

Overall survival curves between MRM and BCS.

Clinicopathologic characteristics

Disease free survival period and overall survival period between MRM and BCS group

Postoperative recurrence pattern, recurrent rate site between MRM and BCS group

References

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Article information Continued

Fig. 1.

Disease free survival curves between MRM and BCS.

Fig. 2.

Overall survival curves between MRM and BCS.

Table 1.

Clinicopathologic characteristics

  No. (%) MRM (%) BCS (%) P-value
Total 618 (100) 91 (100) 527 (100)  
Age (year)       0.63
<40 92 (14.9) 15 (16.5) 77 (14.6)  
≥ 40 526 (85.1) 76 (83.5) 450 (85.4)  
T stage       0.82
T1 324 (52.4) 49 (53.8) 275 (52.2)  
T2 294 (47.6) 42 (46.2) 252 (47.8)  
N stage       1.00
N0 539 (87.2) 80 (87.9) 459 (87.1)  
N1 79 (12.8) 11 (12.1) 68 (12.9)  
Estrogen receptor       0.14
(+) 336 (54.4) 56 (61.5) 280 (53.1)  
(-) 282 (45.6) 35 (38.5) 247 (46.9)  
Progesterone receptor       0.31
(+) 299 (48.4) 49 (53.8) 250 (47.4)  
(-) 319 (51.6) 42 (46.2) 277 (52.6)  
HER-2 expression       0.11
(+) 336 (54.4) 42 (46.2) 294 (55.8)  
(-) 272 (45.6) 49 (53.8) 233 (44.2)  
Histologic grade       0.07
I 119 (19.2) 22 (24.2) 97 (18.4)  
II 221 (35.8) 38 (41.7) 183 (34.7)  
III 278 (45.0) 31 (34.1) 247 (46.9)  
Lymphatic invasion       0.45
(+) 171 (27.7) 22 (24.2) 149 (28.3)  
(-) 447 (72.3) 69 (75.8) 378 (71.7)  
Vascular invasion       1.00
(+) 175 (28.3) 26 (28.6) 149 (28.3)  
(-) 443 (71.7) 65 (71.4) 378 (71.7)  
Molecular subtype       0.18
Luminal A 204 (33.0) 38 (41.8) 166 (31.5)  
Luminal B 205 (33.2) 29 (31.9) 176 (33.4)  
HER-2+ 131 (21.2) 13 (14.3) 118 (22.4)  
Triple negative 78 (12.6) 11 (12.1) 67 (12.7)  

BCS=Breast conserving surgery, MRM= Modified radical mastectomy

Table 2.

Disease free survival period and overall survival period between MRM and BCS group

  Mean time (month) 95% CI HR P-value
Disease free survival     0.36 <0.01
MRM 108.46 96.32-120.61    
BCS 80.82 71.75-89.89    
Overall survival     0.71 0.67
MRM 119.25 108.27–130.24    
BCS 121.96 110.76–133.15    

BCS=breast conserving surgery, CI=confidence interval, HR=hazard ratio, MRM=modified radical mastectomy

Table 3.

Postoperative recurrence pattern, recurrent rate site between MRM and BCS group

  MRM (%) BCS (%) P-value
Total 10 (100) 49 (100) 0.36
Recurrence pattern     0.21
Local recurrence 1 (10.0) 14 (28.6)  
Systemic recurrence 9 (90.0) 35 (71.4)  
Local recurrent site     0.23
Ipsilateral chest wall 1 (10.0) 2 (4.1)  
Ipsilateral breast 0 (0) 3 (6.1)  
Supraclavicular node 0 (0) 6 (12.2)  
Ipsilateral axillary node 0 (0) 3 (6.1)  
Systemic recurrent site     0.09
Bone 7 (70.0) 10 (20.4)  
Contralateral breast 1 (10.0) 8 (16.3)  
Lung 1 (10.0) 6 (12.2)  
Brain 0 (0) 6 (12.2)  
Liver 0 (0) 5 (10.2)  

BCS=breast conserving surgery, MRM=modified radical mastectomy