Breast-Conserving Therapy Has Better Prognosis for Tumors in the Central and Nipple Portion of Breast Cancer Compared with Mastectomy: A SEER Data-Based Study.

Jing Wang,Xiaoyu Wang,Guosheng Ren,Hongzhong Li,Yunhai Li,Xue Li,Jie Li,Jiefeng Huang,Zhenyu Zhong,Jiazheng Sun

doi:10.3389/fonc.2021.642571

Abstract

Background and ObjectivesCurrently, the location of primary tumor was an independent prognostic factor of breast cancer. Tumors in the central and nipple portion (TCNP) had poor prognosis compared to other peripheral quadrants. The breast-conserving therapy (BCT) is becoming increasingly common worldwide in breast cancer operations. However, whether the availability of BCT was performed for TCNP remained a matter of debate. We sought to investigate whether BCT was suitable for TCNP with respect to survival outcomes, compared with mastectomy therapy.MethodsUtilizing the Surveillance, Epidemiology, and End Results (SEER) database, we obtained TCNP breast cancer patients diagnosed during the period of 2010–2015. One-to-one (1:1) propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of BCT and mastectomy groups. Univariate and multivariate Cox proportional hazard models were applied to estimate the factors associated with breast cancer-specific survival (BCSS) and overall survival (OS). Survival analysis was performed with the Kaplan–Meier method.ResultsIn the overall cohort, a total of 9,900 patients were enrolled. We found that patients with BCT showed significantly better BCSS (log-rank, p < 0.001) and OS (log-rank, p < 0.001) than the mastectomy group before PSM. The same finding was also shown in 5,820 patients after PSM. Additionally, none of the subgroups, including age, sex, race, histological grade, AJCC stage, and molecular subtype undergoing mastectomy therapy, had better BCSS than BCT.ConclusionsOur study was the first research to show that BCT exhibited superior prognosis in the cohort of TCNP from SEER databases than mastectomy therapy. This finding could provide a cue for treatment strategies for suitable TCNP patients, especially those with a strong willingness to conserve their breasts.

Highlights

As the most common cancer in American women, breast cancer remains second to lung cancer in mortality rate, accounting for about 15% of all cancers this year [1]
According to the type of surgery and receipt of RT, all of these patients were divided into two groups: the breast-conserving therapy (BCT) group (n = 3,536, 35.7%) and the mastectomy therapy group (n = 6,364, 64.3%)
The majority of patients in both the BCT group and the mastectomy group were aged older than 50 years (86.6% and 78.2%)

Summary

Introduction

As the most common cancer in American women, breast cancer remains second to lung cancer in mortality rate, accounting for about 15% of all cancers this year [1]. Tumors in the central and nipple portion (TCNP) had poorer prognosis and more aggressive clinicopathological characteristics than peripheral quadrants [9]. With consideration of recurrence rate and survival time, previous surgeons mostly made non-conservative operations for tumor in the central location [17, 18]. Large-sample studies concerning the comparison of prognosis between BCT and mastectomy therapy for TCNP of breast cancer are scarce. The location of primary tumor was an independent prognostic factor of breast cancer. Tumors in the central and nipple portion (TCNP) had poor prognosis compared to other peripheral quadrants. The breast-conserving therapy (BCT) is becoming increasingly common worldwide in breast cancer operations. We sought to investigate whether BCT was suitable for TCNP with respect to survival outcomes, compared with mastectomy therapy

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