Analysis of prognosis and factors related to locoregional recurrence after breast conserving surgery and modified radical mastectomy in patients with stage <b>Ⅰ</b>–<b>Ⅱ</b> breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIAO Qi , MENG Lei , HE Junfeng , WANG Yuanyuan , LI Zhao , DOU Yi , XIONG Wei ,  TAN Jinxiang

Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

TAN Jinxiang, Email: tjx1202@163.com

Keywords：

breast cancer; breast conserving surgery; modified radical mastectomy; locoregional recurrence; prognosis

DOI：

10.7507/1007-9424.202002012

Video：

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Objective To investigate the prognosis after breast conserving surgery (BCS) and modified radical mastectomy (MRM) in patients with stage Ⅰ–Ⅱ breast cancer, and analyze the factors related to locoregional recurrence (LRR).Methods The clinicopathologic and prognostic data of patients with stage Ⅰ–Ⅱ breast cancer who underwent the surgical treatment in the First Affiliated Hospital of Chongqing Medical University from January 2011 to December 2014 were analyzed. The clinicopathologic characteristics and prognostic differences of the BCS group and MRM group were compared. The factors related to LRR of patients underwent the BCS and MRM were analyzed.Results A total of 1 330 patients with stage Ⅰ–Ⅱ breast cancer were included in this study, including 230 in the BCS group and 1 100 in the MRM group. Compared with the MRM group, the patients in the BCS group had higher height (P<0.001), younger age (P<0.001), smaller tumor diameter (P<0.001), and less axillary lymph node metastasis (P<0.001). Up to August 2019, 149 cases (18 cases in the BCS group and 131 cases in the MRM group) were lost, with a follow-up rate of 88.8%. The median follow-up time was 71 months (4－103 months). The LRR rate of the BCS group was higher than that of the MRM group (6.1% versus 2.5%, χ²=7.002, P<0.01). The locoregional recurrence-free survival of the MRM group was better than that of the BCS group (χ²=7.886, P<0.01). However, there were no statistical differences between the two groups in terms of the distant metastasis-free survival and disease-free survival (P>0.05). In the patients underwent the BCS, the HER-2 was associated with the LRR (P<0.05), and the axillary lymph node metastasis was associated with the LRR in the patients underwent the MRM (P<0.05).Conclusions According to results of this study, although there is a significant difference in locoregional recurrence-free survival between BCS group and MRM group in patients with stage Ⅰ–Ⅱ breast cancer, there are no statistical differences in distant metastasis-free survival and disease-free survival between the two groups. Therefore, it is safe and feasible for choosing appropriate patients with stage Ⅰ–Ⅱ breast cancer to underwent breast-conserving treatment.

Citation： XIAO Qi, MENG Lei, HE Junfeng, WANG Yuanyuan, LI Zhao, DOU Yi, XIONG Wei, TAN Jinxiang. Analysis of prognosis and factors related to locoregional recurrence after breast conserving surgery and modified radical mastectomy in patients with stage Ⅰ–Ⅱ breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1397-1402. doi: 10.7507/1007-9424.202002012 Copy

1.	Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2.	Du X, Freeman DH Jr, Syblik DA. What drove changes in the use of breast conserving surgery since the early 1980s? The role of the clinical trial, celebrity action and an NIH consensus statement. Breast Cancer Res Treat, 2000, 62(1): 71-79.
3.	Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: Breast cancer-specific survival and the influence of prognostic factors in 129 692 patients. Int J Cancer, 2018, 142(1): 165-175.
4.	Corradini S, Reitz D, Pazos M, et al. Mastectomy or breast-conserving therapy for early breast cancer in real-life clinical practice: outcome comparison of 7 565 cases. Cancers (Basel), 2019, 11(2): pii: E160.
5.	van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
6.	Li H, Chen Y, Wang X, et al. T1-2N0M0 triple-negative breast cancer treated with breast-conserving therapy has better survival compared to mastectomy: A SEER population-based retrospective analysis. Clin Breast Cancer, 2019, 19(6): e669-e682.
7.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范 (2019 年版). 中国癌症杂志, 2019, 29(8): 609-679.
8.	Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
9.	Bao X, Sun K, Tian X, et al. Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006–2015) retrospective hospitalization summary report-based study. Thorac Cancer, 2018, 9(6): 707-717.
10.	Chiu AS, Thomas P, Killelea BK, et al. Regional variation in breast cancer surgery: Results from the National Cancer Database (NCDB). Am J Surg, 2017, 214(5): 907-913.
11.	Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer, 2010, 46(13): 2344-2356.
12.	Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
13.	Fisher B, Wolmark N. New concepts in the management of primary breast cancer. Cancer, 1975, 36(2): 627-632.
14.	Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
15.	Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ–Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 random ised trial. Lancet Oncol, 2012, 13(4): 412-419.
16.	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
17.	Elsayed M, Alhussini M, Basha A, et al. Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery. World J Surg Oncol, 2016, 14: 144.
18.	van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst, 2000, 92(14): 1143-1150.
19.	Belkacemi Y, Hanna NE, Besnard C, et al. Local and regional breast cancer recurrences: salvage therapy options in the new era of molecular subtypes. Front Oncol, 2018, 8: 112.
20.	Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol, 2010, 28(10): 1684-1691.
21.	Tovar JR, Zandonade E, Amorim MH. Factors associated with the incidence of local recurrences of breast cancer in women who underwent conservative surgery. Int J Breast Cancer, 2014, 2014: 639534.
22.	Lertsithichai P, Sakulchairungreung B, Chirappapha P, et al. Effect of young age, positive margins, and triple negative status on disease recurrence after breast conserving therapy. Gland Surg, 2016, 5(1): 15-23.
23.	Wong FY, Tham WY, Nei WL, et al. Age exerts a continuous effect in the outcomes of Asian breast cancer patients treated with breast-conserving therapy. Cancer Commun (Lond), 2018, 38(1): 39.
24.	Merino T, Ip T, Domínguez F, et al. Risk factors for loco-regional recurrence in breast cancer patients: a retrospective study. Oncotarget, 2018, 9(54): 30355-30362.
25.	Botteri E, Bagnardi V, Rotmensz N, et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol, 2010, 21(4): 723-728.
26.	Sjöström M, Lundstedt D, Hartman L, et al. Response to radiotherapy after breast-conserving surgery in different breast cancer subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial. J Clin Oncol, 2017, 35(28): 3222-3229.
27.	McGuire A, Lowery AJ, Kell MR, et al. Locoregional recurrence following breast cancer surgery in the trastuzumab era: a systematic review by subtype. Ann Surg Oncol, 2017, 24(11): 3124-3132.
28.	Bellon JR, Guo H, Barry WT, et al. Local-regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial). Breast Cancer Res Treat, 2019, 176(2): 303-310.
29.	Fragomeni SM, Sciallis A, Jeruss JS. Molecular subtypes and local-regional control of breast cancer. Surg Oncol Clin N Am, 2018, 27(1): 95-120.
30.	Tsoutsou PG, Vozenin MC, Durham AD, et al. How could breast cancer molecular features contribute to locoregional treatment decision making? Crit Rev Oncol Hematol, 2017, 110: 43-48.
31.	Gangi A, Chung A, Mirocha J, et al. Breast-conserving therapy for triple-negative breast cancer. JAMA Surg, 2014, 149(3): 252-258.
32.	Moran MS. Radiation therapy in the locoregional treatment of triple-negative breast cancer. Lancet Oncol, 2015, 16(3): e113-e122.
33.	Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
34.	Frandsen J, Ly D, Cannon G, et al. In the modern treatment era, is breast conservation equivalent to mastectomy in women younger than 40 years of age? A multi-institution study. Int J Radiat Oncol Biol Phys, 2015, 93(5): 1096-1103.
35.	Li Q, Wu S, Zhou J, et al. Risk factors for locoregional recurrence after postmastectomy radiotherapy in breast cancer patients with four or more positive axillary lymph nodes. Curr Oncol, 2014, 21(5): e685-e690.
36.	Sopik V, Sun P, Narod SA. The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients. Breast Cancer Res Treat, 2017, 165(2): 391-402.
37.	Sharma R, Bedrosian I, Lucci A, et al. Present-day locoregional control in patients with T1 or T2 breast cancer with 0 and 1 to 3 positive lymph nodes after mastectomy without radiotherapy. Ann Surg Oncol, 2010, 17(11): 2899-2908.
38.	Jagsi R, Raad RA, Goldberg S, et al. Locoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy: Implications for postmastectomy radiation. Int J Radiat Oncol Biol Phys, 2005, 62(4): 1035-1039.
39.	Selz J, Stevens D, Jouanneau L, et al. Prognostic value of molecular subtypes, ki67 expression and impact of postmastectomy radiation therapy in breast cancer patients with negative lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys, 2012, 84(5): 1123-1132.
40.	Truong PT, Lesperance M, Culhaci A, et al. Patient subsets with T1-T2, node-negative breast cancer at high locoregional recurrence risk after mastectomy. Int J Radiat Oncol Biol Phys, 2005, 62(1): 175-182.
41.	Albert JM, Gonzalez-Angulo AM, Guray M, et al. Estrogen/progesterone receptor negativity and HER2 positivity predict locoregional recurrence in patients with T1a, bN0 breast cancer. Int J Radiat Oncol Biol Phys, 2010, 77(5): 1296-1302.

1. Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res, 2018, 30(1): 1-12.
2. Du X, Freeman DH Jr, Syblik DA. What drove changes in the use of breast conserving surgery since the early 1980s? The role of the clinical trial, celebrity action and an NIH consensus statement. Breast Cancer Res Treat, 2000, 62(1): 71-79.
3. Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: Breast cancer-specific survival and the influence of prognostic factors in 129 692 patients. Int J Cancer, 2018, 142(1): 165-175.
4. Corradini S, Reitz D, Pazos M, et al. Mastectomy or breast-conserving therapy for early breast cancer in real-life clinical practice: outcome comparison of 7 565 cases. Cancers (Basel), 2019, 11(2): pii: E160.
5. van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
6. Li H, Chen Y, Wang X, et al. T1-2N0M0 triple-negative breast cancer treated with breast-conserving therapy has better survival compared to mastectomy: A SEER population-based retrospective analysis. Clin Breast Cancer, 2019, 19(6): e669-e682.
7. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范 (2019 年版). 中国癌症杂志, 2019, 29(8): 609-679.
8. Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
9. Bao X, Sun K, Tian X, et al. Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10-year (2006–2015) retrospective hospitalization summary report-based study. Thorac Cancer, 2018, 9(6): 707-717.
10. Chiu AS, Thomas P, Killelea BK, et al. Regional variation in breast cancer surgery: Results from the National Cancer Database (NCDB). Am J Surg, 2017, 214(5): 907-913.
11. Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer, 2010, 46(13): 2344-2356.
12. Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol, 2013, 24(9): 2206-2223.
13. Fisher B, Wolmark N. New concepts in the management of primary breast cancer. Cancer, 1975, 36(2): 627-632.
14. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
15. Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ–Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 random ised trial. Lancet Oncol, 2012, 13(4): 412-419.
16. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
17. Elsayed M, Alhussini M, Basha A, et al. Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery. World J Surg Oncol, 2016, 14: 144.
18. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst, 2000, 92(14): 1143-1150.
19. Belkacemi Y, Hanna NE, Besnard C, et al. Local and regional breast cancer recurrences: salvage therapy options in the new era of molecular subtypes. Front Oncol, 2018, 8: 112.
20. Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol, 2010, 28(10): 1684-1691.
21. Tovar JR, Zandonade E, Amorim MH. Factors associated with the incidence of local recurrences of breast cancer in women who underwent conservative surgery. Int J Breast Cancer, 2014, 2014: 639534.
22. Lertsithichai P, Sakulchairungreung B, Chirappapha P, et al. Effect of young age, positive margins, and triple negative status on disease recurrence after breast conserving therapy. Gland Surg, 2016, 5(1): 15-23.
23. Wong FY, Tham WY, Nei WL, et al. Age exerts a continuous effect in the outcomes of Asian breast cancer patients treated with breast-conserving therapy. Cancer Commun (Lond), 2018, 38(1): 39.
24. Merino T, Ip T, Domínguez F, et al. Risk factors for loco-regional recurrence in breast cancer patients: a retrospective study. Oncotarget, 2018, 9(54): 30355-30362.
25. Botteri E, Bagnardi V, Rotmensz N, et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol, 2010, 21(4): 723-728.
26. Sjöström M, Lundstedt D, Hartman L, et al. Response to radiotherapy after breast-conserving surgery in different breast cancer subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial. J Clin Oncol, 2017, 35(28): 3222-3229.
27. McGuire A, Lowery AJ, Kell MR, et al. Locoregional recurrence following breast cancer surgery in the trastuzumab era: a systematic review by subtype. Ann Surg Oncol, 2017, 24(11): 3124-3132.
28. Bellon JR, Guo H, Barry WT, et al. Local-regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial). Breast Cancer Res Treat, 2019, 176(2): 303-310.
29. Fragomeni SM, Sciallis A, Jeruss JS. Molecular subtypes and local-regional control of breast cancer. Surg Oncol Clin N Am, 2018, 27(1): 95-120.
30. Tsoutsou PG, Vozenin MC, Durham AD, et al. How could breast cancer molecular features contribute to locoregional treatment decision making? Crit Rev Oncol Hematol, 2017, 110: 43-48.
31. Gangi A, Chung A, Mirocha J, et al. Breast-conserving therapy for triple-negative breast cancer. JAMA Surg, 2014, 149(3): 252-258.
32. Moran MS. Radiation therapy in the locoregional treatment of triple-negative breast cancer. Lancet Oncol, 2015, 16(3): e113-e122.
33. Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
34. Frandsen J, Ly D, Cannon G, et al. In the modern treatment era, is breast conservation equivalent to mastectomy in women younger than 40 years of age? A multi-institution study. Int J Radiat Oncol Biol Phys, 2015, 93(5): 1096-1103.
35. Li Q, Wu S, Zhou J, et al. Risk factors for locoregional recurrence after postmastectomy radiotherapy in breast cancer patients with four or more positive axillary lymph nodes. Curr Oncol, 2014, 21(5): e685-e690.
36. Sopik V, Sun P, Narod SA. The prognostic effect of estrogen receptor status differs for younger versus older breast cancer patients. Breast Cancer Res Treat, 2017, 165(2): 391-402.
37. Sharma R, Bedrosian I, Lucci A, et al. Present-day locoregional control in patients with T1 or T2 breast cancer with 0 and 1 to 3 positive lymph nodes after mastectomy without radiotherapy. Ann Surg Oncol, 2010, 17(11): 2899-2908.
38. Jagsi R, Raad RA, Goldberg S, et al. Locoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy: Implications for postmastectomy radiation. Int J Radiat Oncol Biol Phys, 2005, 62(4): 1035-1039.
39. Selz J, Stevens D, Jouanneau L, et al. Prognostic value of molecular subtypes, ki67 expression and impact of postmastectomy radiation therapy in breast cancer patients with negative lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys, 2012, 84(5): 1123-1132.
40. Truong PT, Lesperance M, Culhaci A, et al. Patient subsets with T1-T2, node-negative breast cancer at high locoregional recurrence risk after mastectomy. Int J Radiat Oncol Biol Phys, 2005, 62(1): 175-182.
41. Albert JM, Gonzalez-Angulo AM, Guray M, et al. Estrogen/progesterone receptor negativity and HER2 positivity predict locoregional recurrence in patients with T1a, bN0 breast cancer. Int J Radiat Oncol Biol Phys, 2010, 77(5): 1296-1302.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of prognosis and factors related to locoregional recurrence after breast conserving surgery and modified radical mastectomy in patients with stage Ⅰ–Ⅱ breast cancer

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