Abstract
Breast-conserving surgery (BCS) including radiotherapy (RT) has been demonstrated to provide at least equivalent prognosis to mastectomy in early-stage breast cancer. However, studies on triple-negative breast cancer (TNBC) patients are relatively scarce. The current population-based study aimed to investigate the distinct outcomes between BCS+RT and mastectomy in patients with TNBC. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled 11,514 female TNBC cases diagnosed during the years 2010–2013. Those patients were subdivided into BCS+RT (5,469) and mastectomy groups (6,045), and we conducted a survival comparison between the two groups. The endpoints were breast cancer-specific survival (BCSS) and overall survival (OS). In the overall cohort, patients with BCS+RT exhibited distinctly better breast cancer-specific survival (BCSS) (log-rank, p < 0.001) and overall survival (OS) (log-rank, p < 0.001) than did mastectomy patients. When stratifying the TNBC patients according to age, histology grade, TNM stage, tumor size, and lymph node (LN) status, most patients in the BCS+RT group presented with better survival than did the patients in the mastectomy group, except for the grade I (log-rank, p = 0.830, both BCSS and OS) and stage I (log-rank, BCSS, p = 0.127; OS, p = 0.093) patients. In addition, after adjusting for confounding variables by multivariable Cox proportional hazard analysis, BCS+RT still tended to present with higher BCSS and OS. In conclusion, from our study on SEER data, BCS+RT displayed elevated BCSS and OS in TNBC patients compared to mastectomy, at least equally. Our study provided further evidence for surgeons that BCS with RT is available for TNBC patients.
Highlights
Breast cancer is the most common cancer among women worldwide
The Breast-conserving surgery (BCS) group had a higher proportion of patients of black race (20.2% VS. 18.7%, P = 0.002) and was much more likely to have a higher proportion of left laterality (52.7% VS. 50.6% P = 0.024)
This study is the first using SEER data to examine the different outcomes between BCS+RT and mastectomy for triple-negative breast cancer (TNBC) patients
Summary
Breast cancer is the most common cancer among women worldwide. We should strive to pursue better treatments for breast cancer. Breast cancers are classified into four distinct subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-overexpressing, and triple-negative breast cancer (TNBC) [2]. Among these types, TNBC characterized by the absence of estrogen receptor (ER) and progesterone receptor (PR) and no HER2 overexpression accounts for 10–20% of invasive breast cancers and shares a considerable overlap with BRCA1-mutated tumors [3, 4]. TNBC tends to exhibit a more aggressive nature, a metastatic pattern, and poorer prognosis compared with other subtypes
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