A Comparison of Clinical Outcomes for Breast-conserving Treatment and Mastectomy for Early Breast Cancer

조기 유방암에서 유방보존치료와 유방절제술 치료성적 비교

  • Noh, Jae-Myoung (Departments of Radiation Oncology, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Departments of Radiation Oncology, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung-Jae (Departments of Radiation Oncology, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo-Ho (Departments of Radiation Oncology, Sungkyunkwan University School of Medicine) ;
  • Yang, Jung-Hyun (Departments of Surgery, Sungkyunkwan University School of Medicine) ;
  • Nam, Seok-Jin (Departments of Surgery, Sungkyunkwan University School of Medicine) ;
  • Kim, Jeong-Han (Departments of Surgery, Sungkyunkwan University School of Medicine) ;
  • Im, Young-Hyuck (Departments of Hematology-oncology, Sungkyunkwan University School of Medicine) ;
  • Ahn, Jin-Seok (Departments of Hematology-oncology, Sungkyunkwan University School of Medicine)
  • 노재명 (성균관대학교 의과대학 방사선종양학교실) ;
  • 박원 (성균관대학교 의과대학 방사선종양학교실) ;
  • 허승재 (성균관대학교 의과대학 방사선종양학교실) ;
  • 최두호 (성균관대학교 의과대학 방사선종양학교실) ;
  • 양정현 (성균관대학교 의과대학 외과학교실) ;
  • 남석진 (성균관대학교 의과대학 외과학교실) ;
  • 김정한 (성균관대학교 의과대학 외과학교실) ;
  • 임영혁 (성균관대학교 의과대학 혈액종양내과학교실) ;
  • 안진석 (성균관대학교 의과대학 혈액종양내과학교실)
  • Published : 2008.03.30

Abstract

Purpose: To compare the treatment outcomes and to analyze prognostic factors between the use of a breast-conserving treatment(BCT) and a mastectomy for early stage breast cancer. Materials and Methods: We retrospectively reviewed 1,200 patients with pathological stage T1-2N0 breast cancer who received surgery between September 1994 and December 2002 at Samsung Medical Center. We compared the patient characteristics and treatment outcomes between the two treatment groups. Results: Among the 1,174 eligible patients, 601(51.2%) patients received a BCT and the remaining 573(48.8%) patients received a mastectomy. The mastectomy group of patients had significantly more cases with a larger tumor size, multicentricity, extensive intraductal component, and estrogen- and progester-one-receptor negativity. The ten-year overall survival rates(OS) of the BCT and mastectomy groups were 91.96% and 91.01%, respectively(p=0.1274). The ten-year disease-free survival rates(DFS) were 80.48% for the BCT group of patients and 84.95% for the mastectomy group of patients, respectively(p=0.8795). Conclusion: Our study shows some differences in patient characteristics between the two treatment groups. However, these differences did not result in significant survival differences.

목적: 조기 유방암에서 유방보존치료와 유방절제술의 치료 성적을 비교하고, 예후 인자를 알아보고자 하였다. 대상 및 방법: 1994년 9월부터 2002년 12월까지 본원에서 근치적 수술을 받은 병리학적 병기 $T1{\sim}2N0$ 유방암 환자 1,200명을 후향적으로 분석하여 유방보존치료와 유방절제술을 사이의 차이를 비교해 보았다. 결과: 분석에 포함된 1,174명의 환자 중 601명이(51.2%) 유방보존치료를 받았고 573명이(48.8%) 유방절제술을 받았다. 유방절제술을 받은 군에서 유의하게 종양의 크기가 컸고, 다발성(multicentricity), 에스트로겐 및 프로게스테론 수용체 음성 등의 인자가 더 많은 경향을 보였다. 유방보존치료 및 유방절제술을 받은 환자의 10년 생존율은 각각 91.96%와 91.01%였고(p=0.1274), 10년 무병생존율은 각각 80.48%와 84.95%(p=0.8795)로 유의한 차이를 보이지 않았다. 결론: 조기 유방암에서 유방보존치료 내지는 유방절제술을 받은 군 사이에 환자 특성의 차이는 일부 있었으나 생존율에서 유의한 차이를 보이지 않았다.

Keywords

References

  1. Annual report of the central cancer registry in Korea (2001-2002). Ministry of Health and Welfare. Republic of Korea 2005
  2. Cancer Incidence in Korea 1999-2001. Ministry of Health and Welfare. Republic of Korea 2005
  3. The Korean Breast Cancer Society. Nationwide Korean breast cancer data of 2004. J Korean Breast Cancer Soc 2006;9:151-161 https://doi.org/10.4048/jbc.2006.9.2.151
  4. The Korean Breast Cancer Study Group. Korean breast cancer data of 1996. J Korean Surg Soc 1998;55:621-635
  5. Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June, 1889 to January, 1894. Johns Hopkins Hosp Bull 1894;4:297
  6. Peters MV. Wedge resection with or without radiation in early breast cancer. Int J Radiat Oncol Biol Phys 1977;2:1151-1156 https://doi.org/10.1016/0360-3016(77)90124-9
  7. Calle R, Vilcoq JR, Zafrani B, Vielh P, Fourquet A. Local control and survival of breast cancer treated by limited surgery followed by irradiation. Int J Radiat Oncol Biol Phys 1986;12:873-878 https://doi.org/10.1016/0360-3016(86)90379-2
  8. Rissanen PM. A comparison of conservative and radical surgery combined with radiotherapy in the treatment of stage I carcinoma of the breast. Br J Radiol 1969;42:423-426 https://doi.org/10.1259/0007-1285-42-498-423
  9. Mustakallio S. Conservative treatment of breast carcinomareview of 25 years follow up. Clin Radiol 1972;23:110-116 https://doi.org/10.1016/S0009-9260(72)80151-X
  10. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-1241 https://doi.org/10.1056/NEJMoa022152
  11. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366:2087-2106 https://doi.org/10.1016/S0140-6736(05)67887-7
  12. Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol 1989;14:177-184 https://doi.org/10.1016/0167-8140(89)90165-5
  13. Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992;11:19-25
  14. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breastconserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000;92:1143-1150 https://doi.org/10.1093/jnci/92.14.1143
  15. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-1232 https://doi.org/10.1056/NEJMoa020989
  16. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003;98:697-702 https://doi.org/10.1002/cncr.11580
  17. Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer 1999;86:628-637 https://doi.org/10.1002/(SICI)1097-0142(19990815)86:4<628::AID-CNCR11>3.0.CO;2-L
  18. Kelemen JJ 3rd, Poulton T, Swartz MT, Jatoi I. Surgical treatment of early-stage breast cancer in the Department of Defense Healthcare System. J Am Coll Surg 2001;192:293-297 https://doi.org/10.1016/S1072-7515(00)00803-6
  19. Lee HD, Suh CO, Jung WH, et al. Partial mastectomy with axillary lymph node dissection and radiotherapy as a new treatment modality of breast cancer (I). Yonsei Med J 1992;33:272-276 https://doi.org/10.3349/ymj.1992.33.3.272
  20. Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic variation in the use of breastconserving treatment for breast cancer. N Engl J Med 1992;326:1102-1107
  21. Samet JM, Hunt WC, Farrow DC. Determinants of receiving breast-conserving surgery. The Surveillance, Epidemiology, and End Results Program, 1983-1986. Cancer 1994;73:2344-2351 https://doi.org/10.1002/1097-0142(19940501)73:9<2344::AID-CNCR2820730917>3.0.CO;2-V
  22. Guadagnoli E, Weeks JC, Shapiro CL, Gurwitz JH, Borbas C, Soumerai SB. Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 1998;16:101-106 https://doi.org/10.1200/JCO.1998.16.1.101
  23. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists' Collaborative Group. N Engl J Med 1995;333:1444-1455 https://doi.org/10.1056/NEJM199511303332202
  24. Son BH, Ahn SH, Kwak BS, et al. The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer. J Korean Breast Cancer 2006;9:134-144 https://doi.org/10.4048/jbc.2006.9.2.134
  25. Society TKBC. Survival analysis of Korean breast cancer patients diagnosed between 1993 and 2002 in Korea - A Nationwide Study of the Cancer Registry. J Korean Breast Cancer 2006;9:214-229 https://doi.org/10.4048/jbc.2006.9.3.214
  26. Kim YS, Yoon SC, Chung SM, Ryu MR, Jung SS, Choi IB. Breast conservation therapy versus mastectomy -preliminary results of pattern of failure and survival rate in early breast cancer. J Korean Soc Ther Radiol Oncol 2004;22:115-123
  27. Yea BK, Bae YT, Sim MS, Moon SE. Clinical analysis of patients with early-stage breast cancer treated by breast-preserving surgery or modified radical mastectomy. J Korean Surg Soc 1998;54:323-333
  28. Lee MZ, Chun HC. Radiation therapy for operable breast cancer after conservative surgery. J Korean Soc Ther Radiol Oncol 2002;20:309-315