The role of tumor phenotype in the surgical treatment of early-stage breast cancer |
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| Institution: | 1. Duke Cancer Institute, Durham, NC, USA;2. Duke University, Department of Biostatistics & Bioinformatics, Durham, NC, USA;3. Duke University Medical Center, Department of Surgery, Durham, NC, USA;4. Yale University, Department of Surgery, New Haven, CT, USA;5. Duke University Medical Center, Department of Population Health Sciences, New Haven, NC, USA;1. Colorado Center for Transplantation Care, Research, and Education (CCTCARE). Department of Surgery, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, C-318, Aurora, CO, 80045, USA;2. University of Colorado School of Medicine, CU Anschutz Fitzsimons Building, 13001 East 17th Place, C290, Aurora, CO, 80045, USA;3. Department of Surgery, Division of Transplant Surgery, Children''s Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA |
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| Abstract: | BackgroundWe investigated whether tumor phenotype influences surgical decision-making, and how that may impact overall survival (OS) for early-stage breast cancer.MethodsWomen aged 18–69 with cT0-2/cN0/cM0 breast cancer in the National Cancer Database (2010–2017) were included. A generalized logistic model was used to identify factors associated with surgery type. A Kaplan-Meier curve was used to visualize unadjusted OS, and the log-rank test was used to test for differences in OS between surgery types.ResultsOf 597,149 patients, 58% underwent lumpectomy with radiation (BCT), 25% unilateral mastectomy (UM), and 17% bilateral mastectomy (BM). After adjustment, HER2+ and triple-negative (TN) tumors were less likely to undergo UM than BCT, versus hormone receptor-positive tumors (OR = 0.881, 95% CI = 0.860–0.903; OR = 0.485, 95% CI = 0.470–0.501). UM and BM had worse 5-year OS versus BCT (UM: 0.926, vs BM: 0.952, vs BCT: 0.960).ConclusionsBCT is increasingly used to treat HER2+ and TN tumors. More extensive surgery is not associated with better survival outcomes, regardless of tumor phenotype. |
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| Keywords: | Breast cancer Breast surgery Tumor phenotype Mastectomy Practice patterns |
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