Document Type : Original Article

Authors

1 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

2 Student Research Committee, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Radiotherapy-Oncology, Omid and Ghaem Hospitals, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Survival after breast conserving surgery (BCS) vs. modified radical mastectomy (MRM) is a controversial issue. In this study, we want to compare the disease-free survival (DFS) of women who underwent BCS with those treated by MRM.
Method: In this historical cohort study, a total of 1097 women who were diagnosed with breast cancer between 2001 and 2007 and received modified MRM or BCS were entered into the study and followed up to March 2017. Kaplan-Meier estimator and extended cox model, and Cox proportional hazards model with propensity score weighting were implemented to compare overall survival between two groups.
Results: A total of 283 women with a maximum follow-up of 11.1 years and age 47.17 ± 11.278 were met the inclusion criteria. The results of the extended cox model did not show any difference between the survival of two groups (P = 0.35). After implementing the Cox model with propensity score weighting, the inferences remained unchanged (P = 0.67).
Conclusion: The patients treated with BCS tend to have the same DFS rate as those who underwent a mastectomy in a randomized controlled trial-like setting using propensity score weighting.

Keywords

How to cite this article:

Ghavami V, Hajebi Khaniki S, Homaei Shandiz F, Akbari Sharak N. Comparison of disease-free survival of breastconserving surgery and mastectomy using propensity score as inverse probability treatment weighting. Middle East J Cancer. 2023;14(1):102- 11. doi: 10.30476/mejc.2022. 91347.1623.

  1. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021. doi: 10.1002/ijc.33588. Epub ahead of print.
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492.
  3. van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial. J Natl Cancer Inst Monogr. 1992;(11):15-8.
  4. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-32. doi: 10.1056/ NEJMoa020989.
  5. Litière S, Werutsky G, Fentiman IS, Rutgers E, Christiaens MR, Van Limbergen E, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13(4):412-9. doi: 10.1016/S1470-2045(12)70042- 6.
  6. Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg. 2015;150(1):9-16. doi: 10.1001/jamasurg.2014.2895.
  7. Garcia-Etienne CA, Tomatis M, Heil J, Friedrichs K, Kreienberg R, Denk A, et al. Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer. 2012;48(13):1947-56. doi:10.1016/j.ejca.2012.03.008.
  8. Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: An epidemiological review. Breast J. 2007;13(4):383- 91. doi: 10.1111/j.1524-4741.2007.00446.x.
  9. Harirchi I, Karbakhsh M, Kashefi A, Momtahen AJ. Breast cancer in Iran: results of a multi-center study. Asian pacific journal of cancer prevention. Asian Pac J Cancer Prev. 2004;5(1):24-7.
  10. Mohammadi E, Aminorroaya A, Fattahi N, Azadnajafabad S, Rezaei N, Farzi Y, et al. Epidemiologic pattern of cancers in Iran; current knowledge and future perspective. J Diabetes Metab Disord. 2020;20(1):825-9.doi: 10.1007/s40200-020- 00654-6.
  11. Meshkat M, Baghestani AR, Zayeri F, Khayamzadeh M, Akbari ME. Survival rate and prognostic factors among Iranian breast cancer patients. Iran J Public Health. 2020;49(2):341-50. doi: 10.18502/ijph. v49i2.3102.
  12. Ghavami V, Mahmoudi M, Foroushani AR, Baghishani H, Shandiz FH, Yaseri M. Long-term disease-free survival of non-metastatic breast cancer patients in Iran: A survival model with competing risks taking cure fraction and frailty into account. Asian Pac J Cancer Prev. 2017; 18(10):2825-32. doi: 10.22034/ APJCP.2017.18.10.2825.
  13. Recio-Saucedo A, Gerty S, Foster C, Eccles D, Cutress RI. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. Breast. 2016;25:1-13. doi: 10.1016/j.breast.2015.11.001.
  14. Almahariq MF, Quinn TJ, Siddiqui Z, Jawad MS, Chen PY, Gustafson GS, et al. Breast conserving therapy is associated with improved overall survival compared to mastectomy in early-stage, lymph nodenegative breast cancer. Radiother Oncol. 2020;142:186-94. doi: 10.1016/j.radonc.2019.09.018.
  15. Sinnadurai S, Kwong A, Hartman M, Tan E, Bhoo- Pathy N, Dahlui M, et al. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open. 2019;3(1): 48-55. doi: 10.1002/bjs5.50111.
  16. Onitilo AA, Engel JM, Stankowski RV, Doi SA. Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res. 2015;13(2):65-73. doi: 10.3121/cmr.2014.1245.
  17. Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK. Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: a NCDB analysis. Oncotarget. 2015;6(37):40127-40. doi: 10.18632/oncotarget.5394.
  18. Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J. Effect of breast conservation therapy vs mastectomy on disease-specific survival for earlystage breast cancer. JAMA Surg. 2014;149(3):267-74. doi: 10.1001/jamasurg.2013.3049.
  19. Coulombe G, Tyldesley S, Speers C, Paltiel C, Aquino- Parsons C, Bernstein V, et al. Is mastectomy superior to breast-conserving treatment for young women? Int J Radiat Oncol Biol Phys. 2007;67(5):1282-90. doi: 10.1016/j.ijrobp.2006.11.032.
  20. Al-Ghazal S, Fallowfield L, Blamey R. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36(15):1938-43. doi: 10.1016/s0959-8049(00) 00197-0.
  21. Lanser AM. Evaluation of methods for survival analysis in the presence of extremely few events per variable [dissertation]. Tennessee: Vanderbilt University Institutional Repository; 2015.
  22. Chen K, Pan Z, Zhu L, Hu T, Peng M, Jia W, et al. Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited: a propensity score-matched analysis. Sci China Life Sci. 2018;61(12):1528-36. doi: 10.1007/s11427-018-9396-x.
  23. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41-55. doi: 10.1093/biomet/70.1.41.
  24. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46(3):399-424. doi: 10.1080/00273171.2011.568786.
  25. R Core Team. R: A language and environment for statistical computing [Internet]. R Foundation for Statistical Computing, Vienna, Austria. 2013 [cited: 2021-03-31]. Available at: https://www.R-project.org/
  26. Wrubel E, Natwick R, Wright GP. Breast-conserving therapy is associated with improved survival compared with mastectomy for early-stage breast cancer: a propensity score matched comparison using the National Cancer Database. Ann Surg Oncol. 2021; 28(2):914-9. doi: 10.1245/s10434-020-08829-4.
  27. Wang J, Wang S, Tang Y, Jing H, Sun G, Jin J, et al. Comparison of treatment outcomes with breastconserving surgery plus radiotherapy versus mastectomy for patients with stage I breast cancer: a propensity score-matched analysis. Clin Breast Cancer. 2018;18(5):e975-e984. doi: 10.1016/j.clbc.2018. 06.002.
  28. van Maaren MC, de Munck L, de Bock GH, Jobsen JJ, van Dalen T, Linn SC, 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):1158-70. doi: 10.1016/S1470-2045(16) 30067-5.
  29. Hartmann-Johnsen OJ, Kåresen R, Schlichting E, Nygård JF. Survival is Better after breast conserving therapy than mastectomy for early stage breast cancer: A registry-based follow-up study of Norwegian women primary operated between 1998 and 2008. Ann Surg Oncol. 2015;22(12):3836-45. doi: 10.1245/s10434- 015-4441-3.
  30. de Boniface J, Szulkin R, Johansson A. Survival after breast conservation versus mastectomy adjusted for comorbidity and socioeconomic status: national 6- year follow-up on 48986 women. JAMA Surg. 2021;156(7):628-37. doi: 10.1001/jamasurg.
  31. Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA. Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer. 2013;119(7): 1402-11. doi: 10.1002/cncr.27795.
  32. Borah BJ, Moriarty JP, Crown WH, Doshi JA. Applications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go? J Comp Eff Res. 2014;3(1):63-78. doi: 10.2217/cer.13.89.
  33. Martin MA, Meyricke R, O'Neill T, Roberts S. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer- -a classification tree approach. BMC Cancer. 2006;6:98. doi: 10.1186/1471-2407-6-98.
  34. Al-Gaithy ZK, Yaghmoor BE, Koumu MI, Alshehri KA, Saqah AA, Alshehri HZ. Trends of mastectomy and breast-conserving surgery and related factors in female breast cancer patients treated at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2009-2017: A retrospective cohort study. Ann Med Surg (Lond). 2019;41:47-52. doi: 10.1016/j.amsu.2019.03.012.
  35. Koksalmis GH, Cetinguc B, Durucu M, Camgoz Akdag H, Gulluoglu BM, Karanlik H, et al. The relative importance of factors influencing the surgeons' choice between mastectomy and breast-conserving surgery for women with breast cancer. Health Care Women Int. 2021:1-10. doi: 10.1080/07399332.2021.2009834.
  36. Machuca MPG, Wu WC, Yu BL, Cheng CT. Determinants of breast-conserving therapy in earlystage breast cancer patients: a nationwide study. Clinical Brast Cancer. 2021; 22(4):e473-e479. doi:10.1016/ j.clbc.2021.11.007.
  37. Galeano Machuca MP, Cheng SC, Jou TH, Cheng CT. Determinants of breast-conserving therapy in the Asian population: A systematic review. World J Surg. 2021;45(3):799-807. doi: 10.1007/s00268-020-05814- 6.