A preliminary prediction model for potentially guiding patient choices between breast conserving surgery and mastectomy in early breast cancer patients; a Dutch experience

Elvira Vos,Bas Groot Koerkamp,Winnifred Van Lankeren,Myriam Hunink,Cornelis Verhoef,Linetta Koppert

doi:10.1007/s11136-017-1740-0

Abstract

PurposeTo guide early stage breast cancer patients to choose between breast conserving surgery (BCS) and mastectomy (MST) considering the predicted cosmetic result and quality of life (QoL).MethodsA decision model was built to compare QoL after BCS and MST. Treatment could result in BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction. QoL for these treatment outcomes were obtained from a previous study and the literature and translated into EuroQoL-5D derived utilities. Chance of good cosmesis after BCS was predicted based on tumor location and tumor/breast volume ratio. The decision model determined whether the expected QoL was superior after BCS or MST based on chance of good cosmesis.ResultsThe mean utility for the treatments such as BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction were 0.908, 0.843, 0.859, and 0.876, respectively. BCS resulted in superior QoL compared to MST in patients with a chance of good cosmesis above 36%. This 36% threshold is reached in case the tumor is located in the upper lateral, lower lateral, upper medial, lower medial, and central quadrant of the breast with a tumor/breast volume ratio below 21.6, 4.1, 15.1, 3.2, and 14.7, respectively.ConclusionsBCS results in superior QoL in patients with tumors in the upper breast quadrants or centrally and a tumor/breast volume ratio below 15. MST results in superior QoL in patients with tumors in the lower breast quadrants and a tumor/breast volume ratio above 4.

Highlights

Stage breast cancer patients and their surgeons are confronted with the complex decision between breast conserving surgery (BCS) with radiotherapy or mastectomy (MST) with or without breast reconstruction
We have previously demonstrated that a good cosmetic result after BCS can be predicted preoperatively by tumor volume/breast volume ratio (TV/BV ratio) and tumor location [6]
The prediction model had an area under the operating characteristic curve (AUC) of 0.827 meaning that in 82.7% of the cases, it correctly discriminated between poor and good cosmesis (Fig. 1)

Summary

Introduction

Stage breast cancer patients and their surgeons are confronted with the complex decision between breast conserving surgery (BCS) with radiotherapy or mastectomy (MST) with or without breast reconstruction. Both have similar overall survival [1,2,3]. In the absence of an oncological contraindication for BCS, the treatment choice is a matter of expected cosmetic result that influences quality of life (QoL) [4, 5]. An objective decision aid taking cosmesis and QoL into consideration does not exist.

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Discussion

Conclusion