Effect Of Breast-conserving Surgery Research Articles

Effects of Breast-Conserving Surgery and Mastectomy on the Survival of Patients with Early-Stage (T1-2N0-1M0) HER2-Positive Breast Cancer: A Propensity Score-Matched Analysis.

Although breast-conserving therapy (BCT) promises at least a similar survival rate for patients with early breast cancer compared with mastectomy, its efficacy in patients with human epidermal growth factor receptor 2 (HER2)-positive tumors remains unclear. Therefore, we conducted this study to explore differential effects of BCT and mastectomy on survival outcomes of patients with early-stage HER2-positive breast cancer. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and basic characteristics of patients who received either BCT or mastectomy were balanced using propensity score matching (PSM). Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression were performed. In total, 20,277 patients were diagnosed with T1-2N0-1M0 HER2-positive breast cancer between 2010 and 2015. After PSM, 6,185 pairs of patients were enrolled for further analysis. Compared with those undergoing mastectomy, patients receiving BCT had superior overall survival (OS) (hazard ratio [HR], 0.63; 95% confidence interval [CI]: 0.55-0.73; p < 0.001) and breast cancer-specific survival (BCSS) (HR: 0.59; 95% CI: 0.48-0.71; p < 0.001). The subgroup analyses revealed that survival outcomes (OS and BCSS) of BCT were better than those of mastectomy among estrogen receptor (ER)+/progesterone receptor (PR)+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes (p < 0.05 for all); however, patients with ER-/PR+/HER2+ subtypes who underwent BCT had similar OS and BCSS (p > 0.05 for both) to those treated with mastectomy. Despite the aggressiveness of the disease, we found that BCT may confer better long-term survival than mastectomy for patients with T1-2N0-1M0 HER2-positive breast cancer, particularly for those with ER+/PR+/HER2+, ER+/PR-/HER2+, and ER-/PR-/HER2+ subtypes. In addition, our study provided insights into the clinical applications of BCT. However, this retrospective study has introduced several inevitable limitations, and further prospective research is warranted to verify these conclusions.

Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer.

BACKGROUNDThe incidence and mortality rate of breast cancer in China rank 120th and 163rd, worldwide, respectively. The incidence of breast cancer is on the rise; the risk increases with age but is slightly reduced after menopause. Early screening, diagnosis, and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIMTo evaluate the clinical value of magnetic resonance imaging (MRI) combined with digital breast tomosynthesis (DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODSThis study was divided into two parts. Firstly, 110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group, respectively. Both groups underwent DBT and MRI examination, and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer. Secondly, according to the operation method, 110 patients with breast cancer were divided into either a breast-conserving group (69 patients) or a modified radical mastectomy group (41 patients). The surgical effect, cosmetic effect, and quality of life of the two groups were compared.RESULTSAmong the 110 cases of breast cancer, 66 were of invasive ductal carcinoma (60.00%), and 22 were of ductal carcinoma in situ (20.00%). Among the 110 cases of benign breast tumors, 55 were of breast fibromas (50.00%), and 27 were of breast adenosis (24.55%). The sensitivity, specificity, and area under the curve (AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%, 84.55%, and 0.791, respectively. The sensitivity, specificity, and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%, 85.45%, and 0.850, respectively. The sensitivity, specificity, and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%, 93.64%, and 0.955, respectively. The blood loss, operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group, and the difference was statistically significant (P < 0.05). After 3 mo of observation, the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group, and the difference was statistically significant (P < 0.05). Before surgery, the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ (P > 0.05). Three months after surgery, the quality-of-life scores in both groups were higher than those before surgery (P < 0.05), and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group (P < 0.05). In the observation of tumor recurrence rate two years after the operation, four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence. There was no significant difference in the recurrence rate between the two groups (χ2 = 0.668, P = 0.414 > 0.05).CONCLUSIONMRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone. Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Effect of breast-conserving surgery and modified radical mastectomy on quality of life of early breast cancer patients

We aimed to explore the clinical efficacy of breast-conserving surgery and modified radical mastectomy on the quality of life (QoL) in patients with early breast cancer. A total of 100 patients treated with breast-conserving surgery (BCS) were recruited in the BCS group, and 100 patients treated with modified radical mastectomy (MRM) in the MRM group. Our results showed that patients had significantly shorter operation time and hospital stay, smaller incisions, and less intraoperative blood loss in the BCS group than in the MRM group. The total complication rate was significantly lower in the BCS. The rate of good-to-excellent aesthetic outcomes in the BCS group was significantly. At one year and three years after surgery, the QoL in the BCS group was significantly higher than that in the MRM group (P<0.0001). In conclusion, BCS is as effective as MRM in early breast cancer, but confers better perioperative and aesthetic outcomes, higher QoL, and lower postoperative complication rate.

Effect of breast-conserving surgery plus radiotherapy versus mastectomy on breast cancer-specific survival for early-stage contralateral breast cancer.

Breast-conserving surgery followed by radiotherapy is recommended in most women with early-stage unilateral breast cancer. However, its role in contralateral breast cancer (CBC) patients remains unclear. This retrospective study aimed to evaluate the breast cancer-specific survival (BCSS) outcomes after breast-conserving surgery plus radiotherapy compared with mastectomy in women with early-stage (T1-2N0-1M0) CBC. Data were extracted from the Surveillance, Epidemiology, and End Results database. BCSS was analyzed using the log-rank method, competing risks regression model, and propensity score matching method. A total of 9,336 early-stage CBC patients were included. After multivariable adjustment, no significant difference in BCSS was found between early-stage CBC patients undergoing breast-conserving surgery plus radiotherapy and those undergoing mastectomy [hazard ratio (HR) 1.11, 95% confidence interval (CI): 0.90-1.37, P=0.329]. BCSS was similar in both treatment groups and in the subgroups stratified by age at first primary breast cancer or CBC diagnosis (≤50, 51-60, and >60 years), time interval between cancers (<0.25, 0.25-4, 5-9, and ≤10 years), stage of first primary breast cancer, T classification of CBC, histology and hormone receptors status of both cancers (all P>0.05). Among patients with N1 disease at CBC diagnosis, breast-conserving surgery plus radiotherapy was associated with a boundary significantly improved BCSS (HR 1.45, 95% CI: 1.00-2.12, P=0.050). Among patients who underwent breast-conserving surgery for first primary cancer, bilateral mastectomy for contralateral cancer did not improve BCSS compared with breast-conserving surgery plus radiotherapy (P>0.05). There was no significant difference in BCSS between breast-conserving surgery plus radiotherapy and mastectomy plus radiotherapy (P>0.05). Stable results were obtained after propensity score matching. Breast-conserving surgery plus radiotherapy did not significantly influence BCSS outcomes of patients with early-stage CBC. Bilateral mastectomy and mastectomy plus radiotherapy did not confer a survival advantage over breast-conserving surgery plus radiotherapy in these patients. Future prospective studies are necessary to expand on these results.

Effect of breast conserving surgery on neurotensin and its receptor 1 in patients with breast cancer

Objective To investigate the effect of breast conserving surgery on neurotensin (NTS) and its receptor 1(NTR1) in patients with breast cancer. Methods From May 2012 to May 2015, 200 patients with breast cancer, aged 44.7 years(range, 32-56 years), were treated at Tiantan Hospital, Capital Medical University. All patients were divided into control group (n=100) and observation group (n=100). The patients in the control group were treated with radical operation and the patients in the observation group were treated with breast-conserving surgery. The positive rate of NTS and NTR1 before and 1 week after operation, WHOQOL-100 (It includes four aspects: physiological state, psychological state, environmental condition and social function) 1 d before surgery, 3 months and 6 months after surgery, and the incidence of postoperative complications 1 week after surgery were compared between the two groups. Measurement data with normal distribution were described as mean±standard deviation (Mean±SD) and analyzed by the t test. Count data were analyzed by chi-square test. Results The positive rate of NTS (17.00%) in the observation group was significantly lower than that in the control group (36.00%) (t=9.267, P=0.002), The positive rate of NTR1 (19.00%) was significantly lower than that in the control group (33.00%) (t=5.094, P=0.024). The physiological status, psychological state, environmental condition and social function of 3 months after surgery of the observation group were (62.57±5.73), (63.48±5.91), (68.73±6.32), (64.06±5.94) scores, respectively, and the control group were (53.47±5.38), (55.62±5.54), (60.38±6.14), (55.86±5.66) scores, respectively, showing statistically significant differences between the two groups (P<0.05). The physiological status, psychological state, environmental condition and social function of 6 months after surgery were (73.74±6.19), (76.27±6.32), (78.85±6.77), (73.53±6.58) scores in the observation group, and (64.18±5.67), (67.38±6.02), (69.64±6.43), (63.28±6.17) scores in the control group, showing statistically significant differences between the two groups (P<0.05). The incidence of postoperative complications in the observation group (6.00%) was significantly lower than that in the control group (18.00%)(P<0.05). Conclusion Breast conserving surgery can reduce the expression level of NTS and NTR1 in breast cancer patients, It is related to reducing the incidence of postoperative complications and improving the quality of life of patients. Key words: Breast neoplasms; Surgical procedures, operative; Breast conserving surgery; Neurotensin; Neurotensin receptor-1

Comparison of effects of breast conserving surgery and modified radical mastectomy for early breast cancer

Objective To compare the clinical effect of breast conserving surgery and modified radical mastectomy for early breast cancer. Methods The clinical data of 100 patients with early breast cancer who received surgical treatment and completed 5 years of follow-up were retrospectively analyzed.According to the operation mode, the patients were divided into the conservative group(47 cases) and radical group (53 cases). The patients underwent breast conserving surgery, surgical treatment of modified radical mastectomy respectively.The objective response rate, the effect of aesthetic breast appearance, postoperative 5 years survival rate, local recurrence rate, distant metastasis rate, survival quality were compared between the two groups. Results The objective remission rate of the conservative group and radical group was 82.98%, 86.79%, respectively, the difference was not statistically significant (χ2=0.284, P>0.05). The aesthetic good rate of the conservative group was 91.49%, which was higher than 0.00% of the radical group (χ2=85.609, P 0.05). The scores of physical health, mental health, social function, quality of life score of material life of the conservative group were (79.37±8.19)points, (83.56±11.21)points, (81.48±10.95)points, (83.19±11.34)points, respectively, which were significantly higher than those of the radical group [(71.58±6.23)points, (71.87±8.65)points, (70.62±9.17)points, (71.76±8.79)points](t=5.388, 5.873, 5.396, 5.666, all P<0.05). Conclusion For patients with early breast cancer, the clinical effect of breast conserving surgery is similar with the modified radical mastectomy, it can effectively improve the breast appearance and the quality of life of patients. Key words: Breast neoplasms; Mammaplasty; Mastectomy, modified radical

10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study

Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery plus radiotherapy might be overestimated. In this study, we aimed to evaluate 10 year overall and breast cancer-specific survival after breast-conserving surgery plus radiotherapy compared with mastectomy in Dutch women with early breast cancer. In this population-based study, we selected all women from the Netherlands Cancer Registry diagnosed with primary, invasive, stage T1-2, N0-1, M0 breast cancer between Jan 1, 2000, and Dec 31, 2004, given either breast-conserving surgery plus radiotherapy or mastectomy, irrespective of axillary staging or dissection or use of adjuvant systemic therapy. Primary outcomes were 10 year overall survival in the entire cohort and breast cancer-specific survival in a representative subcohort of patients diagnosed in 2003 with characteristics similar to the entire cohort. We estimated breast cancer-specific survival by calculating distant metastasis-free and relative survival for every tumour and nodal category. We did multivariable Cox proportional hazard analysis to estimate hazard ratios (HRs) for overall and distant metastasis-free survival. We estimated relative survival by calculating excess mortality ratios using life tables of the general population. We did multiple imputation to account for missing data. Of the 37 207 patients included in this study, 21 734 (58%) received breast-conserving surgery plus radiotherapy and 15 473 (42%) received mastectomy. The 2003 representative subcohort consisted of 7552 (20%) patients, of whom 4647 (62%) received breast-conserving surgery plus radiotherapy and 2905 (38%) received mastectomy. For both unadjusted and adjusted analysis accounting for various confounding factors, breast-conserving surgery plus radiotherapy was significantly associated with improved 10 year overall survival in the whole cohort overall compared with mastectomy (HR 0·51 [95% CI 0·49-0·53]; p<0·0001; adjusted HR 0·81 [0·78-0·85]; p<0·0001), and this improvement remained significant for all subgroups of different T and N stages of breast cancer. After adjustment for confounding variables, breast-conserving surgery plus radiotherapy did not significantly improve 10 year distant metastasis-free survival in the 2003 cohort overall compared with mastectomy (adjusted HR 0·88 [0·77-1·01]; p=0·07), but did in the T1N0 subgroup (adjusted 0·74 [0·58-0·94]; p=0·014). Breast-conserving surgery plus radiotherapy did significantly improve 10 year relative survival in the 2003 cohort overall (adjusted 0·76 [0·64-0·91]; p=0·003) and in the T1N0 subgroup (adjusted 0·60 [0·42-0·85]; p=0·004) compared with mastectomy. Adjusting for confounding variables, breast-conserving surgery plus radiotherapy showed improved 10 year overall and relative survival compared with mastectomy in early breast cancer, but 10 year distant metastasis-free survival was improved with breast-conserving surgery plus radiotherapy compared with mastectomy in the T1N0 subgroup only, indicating a possible role of confounding by severity. These results suggest that breast-conserving surgery plus radiotherapy is at least equivalent to mastectomy with respect to overall survival and may influence treatment decision making for patients with early breast cancer. None.

Comprehensive therapy of early breast cancer after breast-conserving surgery

For the patients with early breast cancer, the effects of breast-conserving surgery combined with radiotherapy and radical resection are equal, and the former shows less adverse reactions and better aesthetic outcome. Because of individual differences and the inherent complexity of tumor, to obtain optimal effects, it is an inevitable trend of making an individual comprehensive therapy, which is a combination of radiotherapy, chemotherapy, endocrine therapy and targeted therapy. Key words: Breast neoplasms; Combined modality therapy; Radiotherapy; Drug Therapy

Clinical effect of breast-conserving surgery on early breast cancer patients

Objective To explore the clinical efficacy of early breast cancer patients underwent breast-conserving surgery with postoperative chemotherapy and radiotherapy.Methods A retrospective analysis of 128 early breast cancer patients underwent routine breast-conserving surgery was conducted.The clinical effect and cosmetic results were analyzed by the follow-up results of 128 cases.Results (1) The 5-year follow-up rate was 100％,overall survival rate was 95.3％,1-year survival rate was 100％ (128/128) ;3-year survival rate was 98.4％ (126/128) ;5-year survival rate was 95.30％ (122/128).Postoperative follow-up 6 patients died,3 patients died of liver metastases,2 patients died of lung metastases,1 patient died of non-cancerous reasons.The local recurrence rate was 2.34％ (3/128),axillary lymph node recurrence rate was 1.56％ (2/128).The average recurrence time was three years and two months after operation,distant metastasis rate was 3.91％ (5/128).(2) Beauty evaluations of 128 patients with breast-conserving surgery were excellent in 71 cases (55.5％),good in 55 cases (43.0％),and poor'in 2 cases (1.6％).Good,acceptable as acceptance criteria,the acceptance rate was 98％.Conclusion Breast-conserving surgery is not only to a certain extent to solve the pursuit of female beauty,but also improve their quality of life.But only the complete elimination of residual lesions in order to truly ensure that no recurrence of tumor.Therefore,the appropilate survival rate of patients for radiotherapy and chemotherapy can be extended so that the patient's breast to maintain a good shape.Breast-conserving surgery combined with radiotherapy and chemotherapy is superior to the modified radical surgery,and popularization in the hospital. Key words: Breast neoplasms ; Early Diagnosis ; Masleclomy, segmental

Of breast-conserving surgery combined with neoadjuvant chemotherapy in advanced breast cancer treatment

Objective To investigate the effect of breast-conserving surgery combined with neoadjuvant chemotherapy in advanced breast cancer.Methods 54 cases with advanced breast cancer from January 2008 to December 2011 in our hospital were selected and analyzed,the curative effects of two methods of neoadjuvant chemotherapy and breast-conserving surgery were compared.Results Before chemotherapy,the total effective rate was 72.22％,the total installments reducing rate was 57.41％,44.44％ of patients acquired breast-conserving surgery conditions after chemotberapy,21 patients were given breast-conserving surgery,and during follow-up period there were no death and recurrence found.Conclusion Through neoadjuvant chemotherapy,some patients with advanced breast cancer might get the breastconserving surgical treatment conditions and the operation should be safe with good prognosis. Key words: Breast-conserving surgery; Neoadjuvant chemotherapy; Advanced breast cancer