Breast-conserving surgery vs. total mastectomy in patients with triple negative breast cancer in early stages: A propensity score analysis

Article type: Research Article

Authors: De-la-Cruz-Ku, Gabriel^a | Valcarcel, Bryan^a; | Morante, Zaida^b | Möller, Mecker G.^c | Lizandro, Sofia^a | Rebaza, Lia P.^b | Enriquez, Daniel^b | Luque, Renato^{a; d} | Luján-Peche, María G.^{a; d} | Eyzaguirre-Sandoval, Miguel E.^{a; d} | Saavedra, Antonella^{a; d} | Razuri, Cesar^e | Pinto, Joseph A.^f | Fuentes, Hugo A.^b | Neciosup, Silvia P.^b | Gomez, Henry L.^b

Affiliations: [a] School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru | [b] Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru | [c] Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Miami, FL, USA | [d] Sociedad científica de estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru | [e] Hospital Nacional Dos de Mayo, Lima, Peru | [f] Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru

Correspondence: [*] Corresponding author: Bryan Valcarcel, MD, School of Medicine, Universidad Científica del Sur, Carr Panamericana Sur 19, Villa el Salvador, 15067 Lima, Peru. Tel.: +51 946451947; E-mail: bryan.valcarcel@gmail.com. ORCID: https://orcid.org/0000-0003-3853-2603

Abstract: BACKGROUND:Breast-conserving surgery (BCS) as an alternative to total mastectomy (TM) in patients with early-stage triple-negative breast cancer (TNBC) is not widely spread. OBJECTIVE:We aimed to compare the overall survival (OS) and disease-free survival (DFS) between both surgical approaches in early-stage TNBC patients at 10 years. METHODS:We conducted a retrospective cohort study in TNBC female patients with stage I-IIa, treated at a single-center during the period of 2000–2014. We estimated and compared the survival rates with the Kaplan Meier and Long-rank test. Propensity scores were calculated with the generalized boosted regression model and were used in the multivariate Cox regression analysis with the covariate adjustment method. RESULTS:We included 288 patients, 111 in the BCS vs. 177 in the TM group. The median follow-up was 102 months. Moreover, the patients in the BCS group had superior OS (85% vs. 81%, p = 0.56) and DFS (83% vs. 80%, p = 0.42) at 10 years. In the multivariate Cox analysis, BCS decreased the mortality risk (HR: 0.79, 95% CI: 0.37–1.67, p = 0.538), and the locoregional or distant recurrence risk (HR: 0.67, 95% CI: 0.32–1.41, p = 0.294), albeit with no statistical significance. CONCLUSION:BCS is a safe alternative to TM in Latin-American patients with early-stage TNBC.

Keywords: Triple negative breast cancer neoplasm, breast-conserving surgery; overall survival, distant disease-free survival, adjuvant chemotherapy

DOI: 10.3233/BD-190391

Journal: Breast Disease, vol. 39, no. 1, pp. 29-35, 2020