Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort
Abstract Cohort studies have suggested that breast-conserving therapy (BCT) offers better survival outcomes compared to mastectomy in patients with early breast cancer (BC). However, survival comparisons between BCT and mastectomy with breast reconstruction (Mastectomy + BR) are lacking. To investig...
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Nature Portfolio
2025-08-01
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| Online Access: | https://doi.org/10.1038/s41598-025-16215-x |
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| author | Hao Li Shen Tian Juan Wu Shu Li Jun Xiao Yu-ling Chen Jing-yu Song Qin Pan Xin-yu Liang Rui-ling She Chen-yu Ma Kai-nan Wu Ling-quan Kong |
| author_facet | Hao Li Shen Tian Juan Wu Shu Li Jun Xiao Yu-ling Chen Jing-yu Song Qin Pan Xin-yu Liang Rui-ling She Chen-yu Ma Kai-nan Wu Ling-quan Kong |
| author_sort | Hao Li |
| collection | DOAJ |
| description | Abstract Cohort studies have suggested that breast-conserving therapy (BCT) offers better survival outcomes compared to mastectomy in patients with early breast cancer (BC). However, survival comparisons between BCT and mastectomy with breast reconstruction (Mastectomy + BR) are lacking. To investigate this, we conducted a cohort study using data from the SEER database. Patients with first-diagnosed locoregional BC between 2010 and 2016 were included and categorized into BCT and Mastectomy + BR groups. Propensity score matching (PSM) was performed to reduce selection bias. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the groups. After PSM, 56,420 patients were matched (1:1) into the BCT and Mastectomy + BR groups. No significant differences in BCSS or OS were observed between the two matched groups overall. However, subgroup analyses based on tumor size and nodal status showed that, among patients with node-negative and tumors ≤ 5 cm, Mastectomy + BR was associated with decreased BCSS compared to BCT (HR 1.23, 95% CI 1.02–1.49, P = 0.03). Inferior BCSS for Mastectomy + BR was also observed in tumors located in the upper-outer quadrant (HR 1.54, 95% CI 1.07–2.20, P = 0.02), nipple & central area (HR 4.98, 95% CI 1.44–17.21, P = 0.01), and in triple-negative BC (HR 1.45, 95% CI 1.07–1.98, P = 0.02). Additionally, in triple-negative BC, Mastectomy + BR was associated with worse OS (HR 1.33, 95% CI 1.00–1.76, P = 0.048). For patients with node-positive or tumors > 5 cm, no significant differences in BCSS or OS were found between the BCT and Mastectomy + BR groups, except in the HER2-enriched subtype, where Mastectomy + BR was associated with improved BCSS (HR 0.43, 95% CI 0.22–0.85, P = 0.015) and a marginal better OS (HR 0.54, 95% CI 0.29–1.01, P = 0.055). This study suggests that, except for the HER2-enriched subtype, BCT remains an equivalent or, in specific clinical scenarios, a superior alternative to Mastectomy + BR for the treatment of breast cancer. |
| format | Article |
| id | doaj-art-5004ba35c4eb41f1b47a86c0296ff1d8 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-08-01 |
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| spelling | doaj-art-5004ba35c4eb41f1b47a86c0296ff1d82025-08-24T11:22:09ZengNature PortfolioScientific Reports2045-23222025-08-0115111310.1038/s41598-025-16215-xSurvival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohortHao Li0Shen Tian1Juan Wu2Shu Li3Jun Xiao4Yu-ling Chen5Jing-yu Song6Qin Pan7Xin-yu Liang8Rui-ling She9Chen-yu Ma10Kai-nan Wu11Ling-quan Kong12Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Nephrology, Zigong First People’s HospitalDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical UniversityAbstract Cohort studies have suggested that breast-conserving therapy (BCT) offers better survival outcomes compared to mastectomy in patients with early breast cancer (BC). However, survival comparisons between BCT and mastectomy with breast reconstruction (Mastectomy + BR) are lacking. To investigate this, we conducted a cohort study using data from the SEER database. Patients with first-diagnosed locoregional BC between 2010 and 2016 were included and categorized into BCT and Mastectomy + BR groups. Propensity score matching (PSM) was performed to reduce selection bias. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared between the groups. After PSM, 56,420 patients were matched (1:1) into the BCT and Mastectomy + BR groups. No significant differences in BCSS or OS were observed between the two matched groups overall. However, subgroup analyses based on tumor size and nodal status showed that, among patients with node-negative and tumors ≤ 5 cm, Mastectomy + BR was associated with decreased BCSS compared to BCT (HR 1.23, 95% CI 1.02–1.49, P = 0.03). Inferior BCSS for Mastectomy + BR was also observed in tumors located in the upper-outer quadrant (HR 1.54, 95% CI 1.07–2.20, P = 0.02), nipple & central area (HR 4.98, 95% CI 1.44–17.21, P = 0.01), and in triple-negative BC (HR 1.45, 95% CI 1.07–1.98, P = 0.02). Additionally, in triple-negative BC, Mastectomy + BR was associated with worse OS (HR 1.33, 95% CI 1.00–1.76, P = 0.048). For patients with node-positive or tumors > 5 cm, no significant differences in BCSS or OS were found between the BCT and Mastectomy + BR groups, except in the HER2-enriched subtype, where Mastectomy + BR was associated with improved BCSS (HR 0.43, 95% CI 0.22–0.85, P = 0.015) and a marginal better OS (HR 0.54, 95% CI 0.29–1.01, P = 0.055). This study suggests that, except for the HER2-enriched subtype, BCT remains an equivalent or, in specific clinical scenarios, a superior alternative to Mastectomy + BR for the treatment of breast cancer.https://doi.org/10.1038/s41598-025-16215-xBreast cancerBreast-conserving therapyMastectomy with breast reconstructionBreast cancer-specific survivalOverall survivalPropensity score matching analysis |
| spellingShingle | Hao Li Shen Tian Juan Wu Shu Li Jun Xiao Yu-ling Chen Jing-yu Song Qin Pan Xin-yu Liang Rui-ling She Chen-yu Ma Kai-nan Wu Ling-quan Kong Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort Scientific Reports Breast cancer Breast-conserving therapy Mastectomy with breast reconstruction Breast cancer-specific survival Overall survival Propensity score matching analysis |
| title | Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| title_full | Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| title_fullStr | Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| title_full_unstemmed | Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| title_short | Survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| title_sort | survival comparison of breast conserving therapy and mastectomy with breast reconstruction for breast cancer using propensity score matched cohort |
| topic | Breast cancer Breast-conserving therapy Mastectomy with breast reconstruction Breast cancer-specific survival Overall survival Propensity score matching analysis |
| url | https://doi.org/10.1038/s41598-025-16215-x |
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