Highlights
- •Tumor phenotype and histology influence patterns of breast cancer surgical care. (82).
- •BCT is increasingly used in the care of HER2+ and triple negative tumors. (75).
- •Tumors with lobular histology and high grade are more likely to undergo mastectomy. (85).
- •More extensive surgery is not associated with better survival. (63).
Abstract
Background
We investigated whether tumor phenotype influences surgical decision-making, and how
that may impact overall survival (OS) for early-stage breast cancer.
Methods
Women 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.
Results
Of 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).
Conclusions
BCT is increasingly used to treat HER2+ and TN tumors. More extensive surgery is not
associated with better survival outcomes, regardless of tumor phenotype.
Keywords
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Article info
Publication history
Published online: September 21, 2022
Accepted:
September 18,
2022
Received in revised form:
July 10,
2022
Received:
April 18,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
