Abstract
IntroductionAlthough central breast cancer is not a contraindication to breast conserving, most surgeons still choose to perform total mastectomy. The safety of breast conserving treatment for central breast cancer is still unclear. The purpose of this study is to evaluate the long-term survival outcome of central breast cancer.Materials and methodsUsing SEER database to explore the trend of surgical procedures for patients with central breast cancer. The patients were divided into breast conserving group and non-breast conserving group. Multivariate logistic regression was used to evaluate predictors of breast conserving surgery in central breast cancer. The clinicopathological variables were adjusted through the multivariable Cox risk model, and the stage and T stage were stratified to compare survival results.ResultsA total of 8702 patients with central breast cancer underwent surgical treatment from 2010 to 2015. There were 3870 patients in the breast conserving group and 4832 patients in the non-breast conserving group. The breast preservation rate was 44.4%, which rose from 39.9% in 2010 to 51% in 2015. Elderly patients (p < 0.001) and low tumor malignancy were predictors of breast conserving therapy. In the 1:1 matched case–control analysis, breast cancer-specific survival (BCSS) (p < 0.001) and overall survival (OS) (p < 0.001) in breast conserving therapy group were still higher than those of non-breast conserving. In the subgroup analysis of T staging and stage, the breast conserving therapy group still had higher OS and BCSS.ConclusionIn central breast cancer, breast-conserving therapy is safe and optional.
Highlights
Central breast cancer is not a contraindication to breast conserving, most surgeons still choose to perform total mastectomy
The research on Breast conserving therapy (BCT) of central breast cancer were few and small sample size though the results showed acceptable recurrence rate of BCT in central breast cancer (4.8–7%) [4,5,6] and the non-inferior survival outcomes [5, 7, 8] compared with non-BCT
Comparing patients treated with non-BCT, patients initially treated with BCT were older at diagnosis (P < 0.001), have lower grade (P < 0.001), lower TNM stage (P < 0.001), lower T stage (P < 0.001), lower N stage (P < 0.001) and more likely to be ER positive at diagnosis (P < 0.001), PR positive at diagnosis (P < 0.001) and HER-2 negative at diagnosis (P < 0.001)
Summary
Central breast cancer is not a contraindication to breast conserving, most surgeons still choose to perform total mastectomy. Recent stunning result was reported from a SEER data based research including 16522 central breast cancer which showed an improved survival rate for centrally located breast cancer (CLBC) receiving BCT [12]. The early studies on the safety of BCT for CLBC [4, 13,14,15,16] or the comparation of oncological outcomes between BCT and non-BCT [7, 8] and the recent SEER based result [12] were all constrained to T1-2 stage without taking T3-4 into account which cannot meet the increasing demand for more cosmetically acceptable breast cancer surgery. A study on the survival difference between BCT and non-BCT in central and NAC, especially in T3-4 subgroup population is urgently need
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