BREAST-CONSERVING SURGERY VERSUS MASTECTOMY FOR TREATMENT OF BREAST CANCER AFTER NEOADJUVANT CHEMOTHERAPY

Abstract

Background: The choice between breast-conserving surgery and mastectomy after neoadjuvant chemotherapy is crucial. Historically, mastectomy was favored, but recent techniques emphasize breast-conserving surgery for similar outcomes. Due to the lack of local data, this study was undertaken to compare these approaches and provide region-specific insights on their effectiveness, aiming to fill the existing knowledge gap.      

Objective: To compare recurrence and survival outcomes between breast conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT).

Methods:  In this study, data of 200 women who had undergone NACT was reviewed. For comparison two equal groups were consisted for women who had received breast conserving surgery and mastectomy after NACT. Mean value between the groups were compared using independent sample t test whereas frequencies were compared using Chi Square test/Fisher’s Exact test. Comparison of breast cancer specific survival was stratified for age, pre-chemotherapy staging and tumor size to address effect modifiers and post stratification chi-square test/Fisher’s Exact test was applied. A p-value≤0.05 was taken as statistically significant.

Results: The mean age of patients in Group A was 43.13 ± 7.80 years, while in Group B it was 46.56 ± 8.09 years. The age difference between the two groups was not statistically significant (p-value = 0.468). Pre-chemotherapy staging revealed that 65% of participants were classified as Stage II, with 62% in Group A and 68% in Group B; this difference was not statistically significant (p-value = 0.529). For Stage III, 35% of participants were classified, with 38% in Group A and 32% in Group B, also showing no significant difference. Mean tumor size was 5.90 ± 2.98 cm across the study. Group A had a mean tumor size of 6.06 ± 2.85 cm, while Group B had 5.74 ± 3.12 cm, with no significant difference (p-value = 0.593). Tumors were categorized into 1-6 cm and 7-12 cm ranges; both groups had 53% of participants with tumors in the 1-6 cm range and 47% in the 7-12 cm range, showing no significant difference (p-value = 0.841). Out of 100 participants, 90 (90.0%) had positive BCSS, with 96.0% in Group A and 84.0% in Group B. This difference was statistically significant (p-value = 0.046). Despite Group A's superior BCSS rate, subgroup analyses did not achieve statistical significance due to small sample sizes.

Conclusion: In conclusion, the study reveals that breast-conserving surgery (Group A) leads to better breast cancer-specific survival (BCSS) rates compared to mastectomy (Group B). Patients in Group A had a higher BCSS rate, suggesting that breast-conserving surgery may offer superior survival outcomes after neoadjuvant chemotherapy. Although subgroup analyses did not yield significant results due to the small sample sizes, the overall findings support the effectiveness of breast-conserving surgery in enhancing survival rates.