Abstract:
BACKGROUND:Recent observational studies are concerning because they document rising mastectomy rates coinciding with more than a dozen reports that lumpectomy has better overall survival (OS) than mastectomy. Our aim was to determine if there were differences in OS of matched breast cancer patients undergoing lumpectomy versus mastectomy in the National Cancer Database (NCDB). PATIENTS AND METHODS:A retrospective cohort of patients with stage I-III breast cancer in the NCDB (2004-2013) was identified. Propensity score matching (PSM), Kaplan-Meier, and multivariate Cox proportional hazards models were used to examine OS by type of surgery. RESULTS:Of 845,136 patients, 464,052 (54.9%) underwent lumpectomy and 381,084 (45.1%) underwent mastectomy. After PSM, the hazard ratio (HR) and confidence interval (CI) for OS in all patients comparing lumpectomy with mastectomy was 1.02 (CI, 1.00-1.04; P = .002). In patients with stage I, II, and III, they were HR 1.27 (CI, 1.23-1.36; P < .001), HR 0.98 (CI, 0.95-1.01; P = .21), and HR 0.83 (CI, 0.80-0.86; P < .001), respectively. In subgroup analyses of all patients by estrogen receptor (ER) status, they were HR 1.05 (CI, 1.03-1.07; P < .001) and HR 1.00 (CI, 0.96-1.03; P = .65) in ER+ and ER- patients. CONCLUSION:In our primary model of all stage I-III matched patients, using the most recent NCDB data and the largest observational sample size to date, the OS after mastectomy was not inferior to lumpectomy. This finding can be reassuring to patients and providers. In subgroup analyses, the association between type of surgery and OS differed by cancer stage and hormone receptor status.
journal_name
Clin Breast Cancerjournal_title
Clinical breast cancerauthors
Landercasper J,Ramirez LD,Borgert AJ,Ahmad HF,Parsons BM,Dietrich LL,Linebarger JHdoi
10.1016/j.clbc.2019.02.006subject
Has Abstractpub_date
2019-06-01 00:00:00pages
e481-e493issue
3eissn
1526-8209issn
1938-0666pii
S1526-8209(18)30861-9journal_volume
19pub_type
杂志文章abstract:INTRODUCTION:Dose-dense therapies have had a major effect on reducing toxicity and improving outcomes in breast cancer. A combination of TC every 3 weeks has emerged as a common chemotherapy regimen used for treatment of node-negative or lower-risk node-positive breast cancer. We tested whether it is feasible to delive...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2013.10.018
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:It has been determined that axillary lymph node dissection after the detection of limited axillary lymph node metastasis does not improve the prognosis of patients with breast cancer. Thus, a need exists for less-invasive axillary surgery. However, it remains unclear whether a predictive model based on preop...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2020.11.008
更新日期:2020-11-17 00:00:00
abstract::Breast cancer patients who present with nodal metastasis receive neoadjuvant chemotherapy (NAC) with increasing frequency and can have complete pathologic response after treatment. In this clinical scenario, sentinel node mapping and biopsy are gaining acceptance instead of axillary dissection to avoid morbidity. Biop...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clbc.2018.01.004
更新日期:2018-08-01 00:00:00
abstract:INTRODUCTION:The purpose of this study was to evaluate the added value of breast magnetic resonance imaging (MRI) in preoperative diagnosis of ductal carcinoma in situ (DCIS). We reviewed our institution database of 3499 consecutive patients treated for breast cancer. PATIENTS AND METHODS:A total of 362 patients with ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2016.12.007
更新日期:2017-06-01 00:00:00
abstract::Post-breast cancer treatment-related angiosarcomas were first observed in lymphedematous extremities after mastectomy and are now being reported with increasing frequency after lumpectomy and radiation. A case history is presented of a BRCA2 carrier who had a postmastectomy chest wall angiosarcoma but had neither ther...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.3816/CBC.2008.n.066
更新日期:2008-12-01 00:00:00
abstract::The management of metastatic breast cancer is changing as a consequence of extraordinary discoveries in cancer research and the development of more advanced diagnostic technologies. Although traditional chemotherapeutics such as anthracyclines and taxanes still represent the mainstay of treatment for this disease, new...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/CBC.2001.n.002
更新日期:2001-01-01 00:00:00
abstract::Breast cancer is the most common cancer affecting women, causing 29% of all female cancers and afflicting 14% of all female cancer-related deaths worldwide. It remains a significant clinical, psychological, and financial burden. Exercise has been suggested to reduce cancer recurrence and cancer-related mortality from ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.06.008
更新日期:2018-10-01 00:00:00
abstract::The clinical utility of capecitabine as a single agent in metastatic breast cancer has been demonstrated with significant responses seen in women already treated with anthracyclines and taxanes. A phase II study in older women with metastatic breast cancer demonstrated capecitabine to be an effective front-line therap...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/cbc.2002.n.004
更新日期:2002-01-01 00:00:00
abstract::Over the past 30 years, much progress has been made in adjuvant chemotherapy for patients with early-stage breast cancer. The introduction of anthracyclines and, recently, taxanes has significantly improved the efficacy of adjuvant chemotherapy and has provided useful insight regarding future development of even more ...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/cbc.2004.s.006
更新日期:2004-01-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.3816/CBC.2011.n.006
更新日期:2011-03-01 00:00:00
abstract:PURPOSE:This multicenter phase II trial evaluated the efficacy and safety of weekly nanoparticle albumin-bound paclitaxel with carboplatin and weekly trastuzumab as first-line therapy for women with HER2-overexpressing metastatic breast cancer (MBC). PATIENTS AND METHODS:We treated 32 patients who had measurable MBC t...
journal_title:Clinical breast cancer
pub_type: 杂志文章,多中心研究
doi:10.3816/CBC.2010.n.036
更新日期:2010-08-01 00:00:00
abstract:INTRODUCTION:There is only limited data from clinical practice on the relevance of body mass index (BMI) on pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) in patients with breast cancer (BC). PATIENTS AND METHODS:The impact of BMI on pCR and survival outcome was examined in 324 patients wi...
journal_title:Clinical breast cancer
pub_type: 杂志文章,meta分析
doi:10.1016/j.clbc.2016.02.018
更新日期:2016-08-01 00:00:00
abstract::Involvement of axillary lymph nodes is an important prognostic factor in relationship to the management of breast cancer. However, the use of neoadjuvant systemic therapy is widespread in the treatment of positive axilla and such treatment leads to downstaging of axillary disease. Hence, the role of targeted axillary ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.06.001
更新日期:2018-10-01 00:00:00
abstract::Despite the widespread use of trastuzumab in the management of patients with HER2-overexpressing metastatic breast cancer, its optimal duration of administration is unknown. We retrospectively reviewed the medical records of 80 such patients who received trastuzumab monotherapy or combination chemotherapy beyond disea...
journal_title:Clinical breast cancer
pub_type: 杂志文章,多中心研究
doi:10.3816/cbc.2003.n.017
更新日期:2003-06-01 00:00:00
abstract::Mucin-1 (MUC-1) is a high-molecular-weight glycoprotein rich in serine and threonine residues that are O-glycosylated. Expression of MUC-1 is increased in breast, ovarian, and other adenocarcinomas, and altered glycosylation results in exposure of novel peptide epitopes and the expression of tumor-associated carbohydr...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/cbc.2003.s.002
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:We studied the extent of BRCA1/2 genetic testing to help select the surgical approach for patients with breast cancer in Japan remains unclear. PATIENTS AND METHODS:The study subjects were female patients with primary unilateral invasive breast cancer considered as candidates for breast-conserving surgery w...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2020.08.004
更新日期:2020-08-20 00:00:00
abstract:BACKGROUND:Breast reconstruction after mastectomy is important in breast cancer care. MATERIALS AND METHODS:A cross-sectional study was designed to assess surgeons' and patients' perceptions toward breast reconstruction. Questionnaires were distributed to general and breast surgeons in East Coast Malaysian hospitals a...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.04.012
更新日期:2018-10-01 00:00:00
abstract::Breast cancer at age 21 is rare, even in individuals who have a genetic predisposition. These early diagnoses are usually the result of a hereditary cancer syndrome. Other contributing factors, such as chemotherapy and radiation for previous malignancies, can also increase the risk of secondary malignancies, including...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2010.11.001
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Letrozole withdrawal for 3 months might permit estrogenic stimulation in residual resistant breast cancer disease susceptible to letrozole reintroduction. We investigated the impact of a 3-month letrozole-free interval on serum estradiol levels in patients with early stage breast cancer. PATIENTS AND METHOD...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2015.03.007
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Nanoparticle albumin-bound paclitaxel (nab-P) and bevacizumab have each demonstrated efficacy in patients with MBC. This trial was designed to further develop nab-P by evaluating its efficacy and safety using every 3 weeks (q3w), every 2 weeks (q2w), or weekly scheduling in combination with bevacizumab as fi...
journal_title:Clinical breast cancer
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.clbc.2013.02.008
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Luminal-type breast cancers are the most abundant subtype. Endocrine therapies targeting estrogen receptor (ER) or estradiol (E2) synthesis have achieved marked improvement in disease-free and overall survival of ER-positive cancers. However, approximately one-third of these cancers are poorly responsive to ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2014.11.002
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Medical isotopes are required for sentinel node lymphoscintigraphy in breast cancer, but are in critical shortage. Our center uses a modification of the standard SC, called CRC, that has been shown to require less medical isotope for the same procedure. Our objective was to determine if there was a significa...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2014.07.006
更新日期:2015-02-01 00:00:00
abstract:INTRODUCTION:The increment of breast cancer screening coverage should lead to an increase in the proportion of early tumors diagnosed and the decrease of the cancer-related mortality. However, the effectiveness of opportunistic mammography screening is not well documented for public health systems in middle-income coun...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2019.04.014
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:We examined tumor genotype characteristics of human epidermal growth factor receptor 2 (HER2)-positive relapsed (R-) and de novo (dn-) metastatic breast cancer (MBC) in trastuzumab-treated patients who were previously not exposed to this agent. MATERIALS AND METHODS:We analyzed genotypes obtained upon deep ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.10.014
更新日期:2019-04-01 00:00:00
abstract:UNLABELLED:The current study examined the impact of re-excision and residual disease on local recurrence after breast conservation treatment for patients with negative margins. Patients with residual disease on re-excision had a higher local recurrence rate than other patients. However, with reasonably low local recurr...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2011.08.003
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Intensive chemotherapy confers benefit to patients with high-risk early breast cancer (BC). We characterized the feasibility and toxicity profile of anthracycline-containing adjuvant chemotherapy (ACAC) in older women with early BC. PATIENTS AND METHODS:Available data from women who received ACAC for BC in ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2015.12.001
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Arm lymphedema is a common complication after axillary lymph node dissection (ALND), and there is no effective treatment. The clinical significance of sentinel lymph node biopsy (SLNB) is to avoid the risk of arm lymphedema caused by ALND in cases in which the nodes are negative for cancer cells. In develope...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2012.10.005
更新日期:2013-06-01 00:00:00
abstract::The perinatal period, childhood, and adolescence are important intervals for breast cancer risk development. Endogenous estrogen exposure is thought to be highest in utero, and exposure to estrogens throughout life plays an important role in increasing breast cancer risk. Some evidence suggests that breast tissue is n...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/CBC.2008.n.038
更新日期:2008-08-01 00:00:00
abstract::A 40-year-old woman, 6 years after mastectomy, lymph node dissection, and locoregional radiation, presented with hepatic metastases, pruritus, and jaundice. Physical examination revealed uniformly jaundiced skin and no arm lymphedema. Ultrasonography confirmed progressive hepatic metastases with no evidence of intrahe...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.3816/CBC.2007.n.055
更新日期:2007-12-01 00:00:00
abstract::Breast cancer is one of the most commonly diagnosed types of cancer in women. Its pathogenesis involves genetic, hormonal, and environmental factors. A large body of evidence indicates that physical activity has positive effects on every aspect of breast cancer evolution, including prevention, medical treatment, and a...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clbc.2017.05.003
更新日期:2017-10-01 00:00:00