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The role of tumor phenotype in the surgical treatment of early-stage breast cancer

Published:September 21, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.029

      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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