Is breast conservation superior to mastectomy in early
stage triple negative breast cancer?
by Omran Saifi, Mohamad Chahrour, Zhuo Li, Jawad Hoballah,
Joseph Panoff, Laura A. Vallow, Youssef H. Zeidan
The Breast: Published:February 09, 2022
Purpose
Compare overall survival (OS) and breast cancer-specific
survival (BCSS) outcomes of breast conservative therapy (BCT) and mastectomy in
a large cohort of patients with early-stage triple negative breast cancer
(TNBC), using a propensity score-based matching approach.
Methods
Surveillance, Epidemiology, and End Results (SEER) database
was used to study the role of RT in early stage TNBC. Primary end points were
OS and BCSS. Cox proportional hazard regression models and Kaplan-Meier plots
were used to generate the desired outcomes. Propensity score matching was done
to minimize bias.
Results
12,761 patients with T1-2N0M0 TNBC as their first malignancy
were retrieved. Of these 7237 had lumpectomy with RT, and 5524 had mastectomy
only. Age, race, marital status, tumor laterality, grade and stage, and receipt
of chemotherapy were prognostic variables for OS and BCSS. Among 4848 matched
subjects, the 5-year OS was significantly higher in patients with lumpectomy
and RT (89%) compared to mastectomy alone (84.5%) (p-value <0.001).
Similarly, BCSS was significantly higher in patients with lumpectomy and RT
(93%) compared to mastectomy alone (91%) (p-value <0.001). On subgroup
analysis, patients who are younger than 40 had similar survival outcomes after
either mastectomy alone or lumpectomy with RT. However, those who are older
than 60, have any grade or T stage had better survival outcomes with lumpectomy
and RT.
Conclusions
Overall, lumpectomy followed by RT is associated with better
OS and BCSS compared to mastectomy in T1-2N0M0 TNBC patients. Further research
is needed to determine the optimal treatment strategy for specific patient
subgroups.
