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Original Article
Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients - Yoon Seok Kim1, Dong Won Ryu2, Chung Han Lee2
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Kosin Medical Journal 2016;31(1):19-29.
DOI: https://doi.org/10.7180/kmj.2016.31.1.19
Published online: February 4, 2016
1Department of Surgery, Busan adventist Hospital, Busan, Korea
2Department of Surgery, College of Medicine, Kosin University, Busan, Korea
- Corresponding Author: Chung Han Lee, Department of Surgery, Kosin University Gospel Hospital, 262, Gamcheon-ro, Seo-gu, Busan, 49267, Korea Tel: +82-51-990-6462 Fax: +82-51-246-6093 E-mail: mammomaster@naver.com
• Received: July 8, 2013 • Revised: October 21, 2013 • Accepted: October 26, 2013
Copyright © 2016 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Objectives
- Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM).
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Methods
- In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected.
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Results
- Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P< 0.01). However, there was no significant correlation between overall survival period and operative methods (P= 0.67). In addition, recurrence pattern (P= 0.21), recurrent rate (P= 0.36) and site (P= 0.45, P= 0.09) were not associated with operative method.
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Conclusions
- In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.
Table 1.Clinicopathologic characteristics
Table 2.Disease free survival period and overall survival period between MRM and BCS group
| Mean time (month) | 95% CI | HR | P-value | |
|---|---|---|---|---|
| Disease free survival | 0.36 | <0.01 | ||
| MRM | 108.46 | 96.32-120.61 | ||
| BCS | 80.82 | 71.75-89.89 | ||
| Overall survival | 0.71 | 0.67 | ||
| MRM | 119.25 | 108.27–130.24 | ||
| BCS | 121.96 | 110.76–133.15 |
Table 3.Postoperative recurrence pattern, recurrent rate site between MRM and BCS group
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- Application of Raman spectroscopy in breast cancer surgery
Yikeun Kim, Sung Ui Jung, Jinhyuk Choi
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XML DownloadComparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients
Fig. 1. Disease free survival curves between MRM and BCS.
Fig. 2. Overall survival curves between MRM and BCS.
Fig. 1.
Fig. 2.
Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients
Clinicopathologic characteristics
| No. (%) | MRM (%) | BCS (%) | P-value | |
|---|---|---|---|---|
| Total | 618 (100) | 91 (100) | 527 (100) | |
| Age (year) | 0.63 | |||
| <40 | 92 (14.9) | 15 (16.5) | 77 (14.6) | |
| ≥ 40 | 526 (85.1) | 76 (83.5) | 450 (85.4) | |
| T stage | 0.82 | |||
| T1 | 324 (52.4) | 49 (53.8) | 275 (52.2) | |
| T2 | 294 (47.6) | 42 (46.2) | 252 (47.8) | |
| N stage | 1.00 | |||
| N0 | 539 (87.2) | 80 (87.9) | 459 (87.1) | |
| N1 | 79 (12.8) | 11 (12.1) | 68 (12.9) | |
| Estrogen receptor | 0.14 | |||
| (+) | 336 (54.4) | 56 (61.5) | 280 (53.1) | |
| (-) | 282 (45.6) | 35 (38.5) | 247 (46.9) | |
| Progesterone receptor | 0.31 | |||
| (+) | 299 (48.4) | 49 (53.8) | 250 (47.4) | |
| (-) | 319 (51.6) | 42 (46.2) | 277 (52.6) | |
| HER-2 expression | 0.11 | |||
| (+) | 336 (54.4) | 42 (46.2) | 294 (55.8) | |
| (-) | 272 (45.6) | 49 (53.8) | 233 (44.2) | |
| Histologic grade | 0.07 | |||
| I | 119 (19.2) | 22 (24.2) | 97 (18.4) | |
| II | 221 (35.8) | 38 (41.7) | 183 (34.7) | |
| III | 278 (45.0) | 31 (34.1) | 247 (46.9) | |
| Lymphatic invasion | 0.45 | |||
| (+) | 171 (27.7) | 22 (24.2) | 149 (28.3) | |
| (-) | 447 (72.3) | 69 (75.8) | 378 (71.7) | |
| Vascular invasion | 1.00 | |||
| (+) | 175 (28.3) | 26 (28.6) | 149 (28.3) | |
| (-) | 443 (71.7) | 65 (71.4) | 378 (71.7) | |
| Molecular subtype | 0.18 | |||
| Luminal A | 204 (33.0) | 38 (41.8) | 166 (31.5) | |
| Luminal B | 205 (33.2) | 29 (31.9) | 176 (33.4) | |
| HER-2+ | 131 (21.2) | 13 (14.3) | 118 (22.4) | |
| Triple negative | 78 (12.6) | 11 (12.1) | 67 (12.7) |
Disease free survival period and overall survival period between MRM and BCS group
| Mean time (month) | 95% CI | HR | P-value | |
|---|---|---|---|---|
| Disease free survival | 0.36 | <0.01 | ||
| MRM | 108.46 | 96.32-120.61 | ||
| BCS | 80.82 | 71.75-89.89 | ||
| Overall survival | 0.71 | 0.67 | ||
| MRM | 119.25 | 108.27–130.24 | ||
| BCS | 121.96 | 110.76–133.15 |
Postoperative recurrence pattern, recurrent rate site between MRM and BCS group
| MRM (%) | BCS (%) | P-value | |
|---|---|---|---|
| Total | 10 (100) | 49 (100) | 0.36 |
| Recurrence pattern | 0.21 | ||
| Local recurrence | 1 (10.0) | 14 (28.6) | |
| Systemic recurrence | 9 (90.0) | 35 (71.4) | |
| Local recurrent site | 0.23 | ||
| Ipsilateral chest wall | 1 (10.0) | 2 (4.1) | |
| Ipsilateral breast | 0 (0) | 3 (6.1) | |
| Supraclavicular node | 0 (0) | 6 (12.2) | |
| Ipsilateral axillary node | 0 (0) | 3 (6.1) | |
| Systemic recurrent site | 0.09 | ||
| Bone | 7 (70.0) | 10 (20.4) | |
| Contralateral breast | 1 (10.0) | 8 (16.3) | |
| Lung | 1 (10.0) | 6 (12.2) | |
| Brain | 0 (0) | 6 (12.2) | |
| Liver | 0 (0) | 5 (10.2) |
Table 1. Clinicopathologic characteristics
BCS=Breast conserving surgery, MRM= Modified radical mastectomy
Table 2. Disease free survival period and overall survival period between MRM and BCS group
BCS=breast conserving surgery, CI=confidence interval, HR=hazard ratio, MRM=modified radical mastectomy
Table 3. Postoperative recurrence pattern, recurrent rate site between MRM and BCS group
BCS=breast conserving surgery, MRM=modified radical mastectomy
