Breast-conserving surgery vs. mastectomy in centrally located breast cancer
10.7659/j.issn.1005-6947.250411
- VernacularTitle:中央区乳腺癌患者保乳与全乳切除的疗效比较
- Author:
Wenjing ZENG
1
;
Shouman WANG
;
Ayong CAO
;
Weizhi XIA
;
Jinyue GAO
;
Liya LI
;
Ziqi TANG
;
Hongmei WANG
;
Juan HUANG
Author Information
1. 中南大学湘雅医院乳腺外科,湖南长沙 410008;湖南省乳腺癌防治临床医学研究中心,湖南长沙 410008
- Publication Type:Journal Article
- Keywords:
Breast Neoplasms;
Mastectomy,Simple;
Organ Sparing Treatments;
Prognosis
- From:
Chinese Journal of General Surgery
2025;34(8):1726-1737
- CountryChina
- Language:Chinese
-
Abstract:
Background and Aims:Centrally located breast cancer(CLBC),due to its proximity to the nipple-areolar complex,has long been treated primarily with mastectomy,while the oncologic safety of breast-conserving surgery(BCS)remains controversial.This study,based on a large-scale database combined with a real-world cohort,compared the survival outcomes of BCS and mastectomy to evaluate the feasibility and oncologic safety of BCS in CLBC patients.Methods:Data of 10 325 female CLBC patients diagnosed between 2010 and 2015 were extracted from the SEER database,including 5 601 patients who underwent BCS and 4 724 who underwent mastectomy.Propensity score matching(PSM)yielded 1 951 matched pairs,and disease-specific survival(DSS)and overall survival(OS)were compared between groups.Cox regression analyses were performed to identify prognostic factors,and subgroup analyses were conducted.Additionally,an independent validation cohort from Xiangya Hospital,Central South University(2015-2016)included 221 BCS and 636 mastectomy patients,with OS and progression-free survival(PFS)assessed.Results:After PSM,baseline characteristics between groups were well balanced.Kaplan-Meier analysis demonstrated no significant differences in DSS or OS between BCS and mastectomy,and 5-,7-,and 10-year OS rates were comparable(all P＞0.05).Subgroup analyses revealed equivalent outcomes for BCS and mastectomy in patients with T1/T2 disease,different HER2 statuses,and those receiving chemotherapy,while in patients receiving radiotherapy,BCS showed significantly better DSS and OS than mastectomy(both P＜0.05).Multivariate Cox regression identified T,N,and M stage,histologic grade,molecular subtype,ER/PR status,and chemotherapy as independent prognostic factors(all P＜0.05),whereas surgical type was not(P＞0.05).The validation cohort confirmed the SEER findings,with no significant differences in OS or PFS between the two groups(both P＞0.05).Conclusions:BCS provides DSS and OS comparable to mastectomy in CLBC patients and may confer additional survival benefits when combined with radiotherapy.These findings suggest that CLBC should not be considered a contraindication to BCS,supporting BCS as a feasible and safe surgical strategy that offers valuable evidence for individualized clinical decision-making and may help improve patients' quality of life.
