Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients<br />

Shuoer Wang; Yidi Sun; Songjiao Zhao; Feng Wei; Gong Yang; Shuoer Wang; Yidi Sun; Songjiao Zhao; Feng Wei; Gong Yang

doi:10.3934/mbe.2020005

Mathematical Biosciences and Engineering

2020, Volume 17, Issue 1: 92-104. doi: 10.3934/mbe.2020005

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Research article

Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients

Running title: BCS had better prognosis than mastectomy for early TNBC patients

1.
Central Laboratory, The Fifth People's Hospital of Shanghai Fudan University, Shanghai 200000, China
2.
Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai 200000, China
3.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200000, China
4.
Key Lab of Computational Biology, CAS-MPG Partner Institute for Computational Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200000, China
5.
Eye and ENT Hospital of Fudan University, Shanghai 200000, China
6.
Department of Gastroenterology, The Fifth People's Hospital of Shanghai Fudan University, Shanghai 200000, China

Received: 28 March 2019 Accepted: 23 August 2019 Published: 26 September 2019

BackgroundTriple-negative breast cancer (TNBC) is a subtype of breast cancer with stronger invasive capacity. For the operation strategies of early staged (stage Ⅰ and stage Ⅱ) TNBC patients, BCS plus radiotherapy (BCS+RT), mastectomy only (MRM only) or MRM plus radiotherapy (MRM+RT) is feasible, but no clear conclusion has been made on the choice of these treatments.

MethodsThe early staged TNBC patients (stage Ⅰ and stage Ⅱ) from the Surveillance, Epidemiology and End Results (SEER) program database between 1973 and 2014 were included in the study. Survival curves, univariate and multivariate cox proportional hazards models and propensity score weighting were applied to evaluate the prognostic impact among BCS+RT, MRM only and MRM+RT for patients.

ResultsBoth overall and cancer-specific survival analysis showed that BCS+RT had better prognostic effect than MRM and MRM+RT in the cohort of early-staged triple-negative breast cancer patients (overall survival, P < 0.001; cancer-specific survival, P < 0.001). By taking all the risk factors into a multivariate cox proportional model, MRM and MRM+RT remained to have detrimental effect on the prognosis compared with BCS+RT as shown by either overall (HR = 1.742, CI = 1.387-2.188, P < 0.001; HR = 1.449, CI = 1.038-2.204, P = 0.029) or cancer-specific survival (HR = 1.876, CI = 1.415-2.489, P < 0.001; HR = 1.701, CI = 1.168-2.478, P = 0.006). After we performed propensity score weighting and integrated the weights for each covariate in the multivariate cox proportional model. BCS+RT remained to be prognostic beneficial compared to the other treatment options (P < 0.001).

ConclusionBCS+RT demonstrated better prognosis than MRM only and MRM+RT treatments for early-staged TNBC patients.
- triple-negative breast cancer (TNBC),
- radiotherapy,
- breast conserving surgery (BCS),
- mastectomy,
- propensity score matching (PSM)
Citation: Shuoer Wang, Yidi Sun, Songjiao Zhao, Feng Wei, Gong Yang. Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients[J]. Mathematical Biosciences and Engineering, 2020, 17(1): 92-104. doi: 10.3934/mbe.2020005

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Abstract

BackgroundTriple-negative breast cancer (TNBC) is a subtype of breast cancer with stronger invasive capacity. For the operation strategies of early staged (stage Ⅰ and stage Ⅱ) TNBC patients, BCS plus radiotherapy (BCS+RT), mastectomy only (MRM only) or MRM plus radiotherapy (MRM+RT) is feasible, but no clear conclusion has been made on the choice of these treatments.

MethodsThe early staged TNBC patients (stage Ⅰ and stage Ⅱ) from the Surveillance, Epidemiology and End Results (SEER) program database between 1973 and 2014 were included in the study. Survival curves, univariate and multivariate cox proportional hazards models and propensity score weighting were applied to evaluate the prognostic impact among BCS+RT, MRM only and MRM+RT for patients.

ResultsBoth overall and cancer-specific survival analysis showed that BCS+RT had better prognostic effect than MRM and MRM+RT in the cohort of early-staged triple-negative breast cancer patients (overall survival, P < 0.001; cancer-specific survival, P < 0.001). By taking all the risk factors into a multivariate cox proportional model, MRM and MRM+RT remained to have detrimental effect on the prognosis compared with BCS+RT as shown by either overall (HR = 1.742, CI = 1.387-2.188, P < 0.001; HR = 1.449, CI = 1.038-2.204, P = 0.029) or cancer-specific survival (HR = 1.876, CI = 1.415-2.489, P < 0.001; HR = 1.701, CI = 1.168-2.478, P = 0.006). After we performed propensity score weighting and integrated the weights for each covariate in the multivariate cox proportional model. BCS+RT remained to be prognostic beneficial compared to the other treatment options (P < 0.001).

ConclusionBCS+RT demonstrated better prognosis than MRM only and MRM+RT treatments for early-staged TNBC patients.

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