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Breast-Conserving Therapy is Associated with Improved Survival Compared with Mastectomy for Early-Stage Breast Cancer: A Propensity Score Matched Comparison Using the National Cancer Database

  • Breast Oncology
  • Published:
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Abstract

Introduction

Current recommendations for early-stage breast cancer are largely based on the NSABP B-06 trial demonstrating equivalent survival between mastectomy and lumpectomy. We sought to compare breast-conserving therapy (BCT) with mastectomy for treatment of early-stage breast cancer in a contemporary patient population.

Methods

A query of the NCDB PUF identified female breast cancer patients diagnosed from 2004 to 2015. Patients with stage I or II disease were included. BCT was defined as the receipt of lumpectomy plus radiation. Propensity scores were tabulated using race, age, Charlson/Deyo score, tumor site, laterality, histology, grade, size, number of nodes positive, lymph-vascular invasion, receptor status, receipt of chemotherapy, and endocrine therapy. Patients who received BCT versus mastectomy were matched using a 1:1 nearest neighbor technique. The primary outcome measured was overall survival.

Results

After exclusions and matching, two equal groups of 101,118 patients remained. Median follow-up was 42 months. The majority had invasive ductal histology (77%), and node-negative disease (84%). Receptor status included ER-positive (83%), PR-positive (73%), and HER2/Neu-positive (15%). Chemotherapy was received in 38% and endocrine therapy in 71%. Propensity score matching yielded equivalent groups across all target variables. The 5-year overall survival was superior for BCT compared with mastectomy (92.9% vs. 89.7%, p < 0.001; Fig. 1). This survival advantage persisted for both stage I (p < 0.001) and stage II (p < 0.001) disease on subgroup analysis.

Overall survival in female patients with early stage invasive breast cancer (stage I or II) undergoing breast conservation surgery with radiation compared with mastectomy. BCS breast conservation surgery

Conclusions

BCT is associated with superior overall survival compared with mastectomy for early-stage breast cancer using well-matched, contemporary data.

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Fig. 2
Fig. 3

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Authors and Affiliations

  1. Spectrum Health General Surgery Residency Program, Grand Rapids, MI, USA

    Erica Wrubel MD, Raylene Natwick MD & G. Paul Wright MD

  2. Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Erica Wrubel MD, Raylene Natwick MD & G. Paul Wright MD

  3. Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA

    G. Paul Wright MD

Authors
  1. Erica Wrubel MD
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  2. Raylene Natwick MD
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  3. G. Paul Wright MD
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Correspondence to Erica Wrubel MD.

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Wrubel, E., Natwick, R. & Wright, G.P. Breast-Conserving Therapy is Associated with Improved Survival Compared with Mastectomy for Early-Stage Breast Cancer: A Propensity Score Matched Comparison Using the National Cancer Database. Ann Surg Oncol 28, 914–919 (2021). https://doi.org/10.1245/s10434-020-08829-4

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  • DOI: https://doi.org/10.1245/s10434-020-08829-4

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