Breast-Conserving Therapy Versus Mastectomy: Long-Term Results From a Matched Pair Analysis

Abstract

Background: We investigated whether primary mastectomy had any significant effect on overall survival as well as on loco-regional and generalized recurrence as opposed to primary breast-conserving therapy (BCT). Patients and Methods: We matched 1574 patients who were treated for breast cancer with regard to tumor size, nodal involvement, grading, patient age and menopausal status. We applied univariate and multivariate analysis to our data, using Kaplan-Meier analysis, log-rank test and the Cox regression model. The median patient follow-up was 58 months. Results: We did not find that the mode of primary surgery had any significant effect on overall survival, but we found that patients who had no nodal involvement at primary surgery and who had BCT had a significantly increased risk of developing local or regional recurrence. Apart from that, the choice of surgical procedure, if correctly indicated, had no influence on overall survival, loco-regional or generalized recurrence. Conclusion: These data support the existing notion that local management of breast cancer should be accomplished using a limited surgical approach combined with radiotherapy. Further studies are needed to determine the correct indications for radiotherapy within the concept of BCT.

Zusammenfassung

Fragestellung: Untersucht wurde, ob die primäre Mastektomie im Vergleich zur primären brusterhaltenden Therapie (BCT) eine signifikante Wirkung auf das Gesamtüberleben und auf die Häufigkeit lokoregionaler und generalisierter Rezidive hat. Patientinnen und Methodik: 1574 Patientinnen, die wegen Brustkrebs behandelt wurden, wurden bei vergleichbarer Tumorgröße, Lymphknotenbeteiligung, Grading, Alter und Menopausenstatus zu Paaren zusammengestellt. Diese Daten wurden einer univariaten und multivariaten statistischen Analyse mittels Kaplan-Meier-Verfahren, Log-rank-Test und Cox-Regressionsmodell unterworfen. Die Patientinnen wurden median 58 Monate nachbeobachtet. Ergebnisse: Es wurde kein signifikanter Effekt der Art der Primäroperation auf das Gesamtüberleben erkennbar, doch stellten wir ein signifikant höheres Risiko für lokale oder regionale Rezidive bei denjenigen Patientinnen fest, die bei der Primäroperation keine Lymphknotenbeteiligung aufwiesen und mittels brusterhaltender Therapie operiert wurden. Ansonsten hatte die Wahl des Operationsverfahrens bei richtiger Indikationsstellung keinen Einfluss auf das Gesamtüberleben oder die Häufigkeit locoregionaler bzw. generalisierter Rezidive. Schlussfolgerungen: Diese Ergebnisse stützen die existierende Auffassung, dass zur lokalen Brustkrebsbehandlung ein begrenztes operatives Verfahren in Kombination mit einer Radiotherapie angewendet werden sollte. Weitere Studien sind erforderlich, um die korrekte Indikation für die Radiotherapie im Rahmen des BCT-Konzeptes zu ermitteln.

mastectomy - breast‐conserving therapy - overall survival - loco‐regional recurrence - generalized recurrence

Mastektomie - brusterhaltende Therapie - Gesamtüberleben - lokoregionale Rezidive - generalisierte Rezidive

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