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126]

Original Article

Breast‑conserving surgery versus modified

radical mastectomy in treatment of early
stage breast cancer: A retrospective study
of 107 cases
ABSTRACT Zhenhong Chen,
Objective: The aim of this retrospective study was to evaluate the clinical efficacy and prognosis of breast‑conserving surgery versus Ying Xu1,
modified radical mastectomy in the treatment of early stage breast cancer.
Jingde Shu,
Naixi Xu
Patients and Methods: Two hundred and nineteen cases of early stage breast cancer were reviewed and retrospectively included
in this study form two hospitals (Quzhou hospitalof Zhejiang university and Quzhou Traditional Chinese Hospital). The characteristics Department of
of operation procedure such as operation time, intraoperative blood loss and length of hospital stay were compared between the Oncology Surgery,
Quzhou Hospital of
two groups. And the prognosis was recurrence rate was also compared to the two groups.
Zhejiang University,
Results: For the included 219 early breast cancer cases, 107 subjects received the breast‑conserving operation, and other 112 cases 1
Department of
received the modified radical mastectomy. The operation time, intraoperative blood loss and length of hospital stay were (56.7 ± 14.6) Surgery, Quzhou
min, (39.2 ± 10.1) ml, (12.1 ± 2.1) day in the breast‑conserving group and (95.6 ± 1 3.5) min, (79.5 ± 13.6) ml, (14.8 ± 3.2) day in the Traditional Chinese
Hospital, Zhejiang,
modified radical mastectomy group respectively. The operation time, intraoperative blood loss and length of hospital stay were smaller in Quzhou 324000, PR
the breast‑conserving group as compared with modified radical mastectomy group with statistical difference (P < 0.05). The overall survival China
was compared with Kaplan–Meier curve by using log‑rank test for the hazard ratio (HR). And the HR was 0.75 with its 95% confidence
interval of 0.38–1.48, which indicated that no statistical difference of overall survival was existed between the two groups (P > 0.05). For correspondence:
Dr. Zhenhong Chen,
Conclusion: The breast‑conserving operation was superior to modified radical mastectomy in the aspects of operation time, Department of
intraoperative blood loss and length of hospital stay. Oncology Surgery,
Quzhou Hospital of
Zhejiang University
KEY WORDS: Breast cancer, breast‑conserving operation, modified radical mastectomy, prognosis Zhejiang, Quzhou
324000, PR China.
E‑mail:
naixixue786@126.com
INTRODUCTION cancer is removed.[6] The goal is to remove cancer
as well as some surrounding normal tissue. In this
Breast cancer is the leading cause of cancer‑related retrospective study, we reviewed and compared
death worldwide for women with increasing trend the prognosis of 219 early breast cancer patients
for recent years. It reported that approximately 230, who received BCS or modified radical mastectomy.
480 new cases of invasive breast cancer and 39,520
breast cancer deaths occurred among US women PATIENTS AND METHODS
in 2011.[1] Surgery is important for the treatment
of early stage breast cancer. And the operation Patients
procedure for breast experienced a long period Two hundred and nineteen cases of early stage
of time.[2] Options for surgery procedure include breast cancer were reviewed and retrospectively Access this article online
breast‑conserving surgery (BCS) and mastectomy.[3,4] included in this study from two hospitals Website: www.cancerjournal.net
For BCS, the breast can be reconstructed at the DOI: 10.4103/0973-1482.163835
This is an open access article distributed under the terms of the Creative Commons
same time as surgery or later on. BCS is also PMID: ***
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
called partial (or segmental) mastectomy. It is also Quick Response Code:
tweak, and build upon the work non-commercially, as long as the author is credited
sometimes called lumpectomy or quadrantectomy.[5] and the new creations are licensed under the identical terms.
In BCS, only the part of the breast containing the For reprints contact: reprints@medknow.com

Cite this article as: Chen Z, Xu Y, Shu J, Xu N. Breast-conserving surgery versus modified radical mastectomy in treatment
of early stage breast cancer: A retrospective study of 107 cases. J Can Res Ther 2015;11:C29-31.

© 2015 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow C29
[Downloaded free from http://www.cancerjournal.net on Wednesday, April 4, 2018, IP: 61.94.238.126]
Chen, et al.: Breast-conserving surgery for breast cancer
(Quzhou Hospital of Zhejiang University and Quzhou
Traditional Chinese Hospital) in the period from December
2006 to November 2012. The inclusion criteria was as flows: (1)
Primary single breast tumor;(2) Tumor from areola o more than
3 cm; (3) The tumor located in the outer quadrant; (4) Tumor
diameter <2 cm; (5) The tumor was confirmed by pathology.
Of the included 219 early stage breast cancer patients, 107
subjects were treated with BCS and other 112 cases received
a modified radical mastectomy. The general characteristics of
the two groups are shown in Table 1.
Methods
Two authors (Chen Zhenhong and Xu Ying) reviewed the
patient’s databases of Quzhou Medical College of Zhejiang
University and Quzhou Central Hospital independently.
We included the early stage breast cancer, according to the
inclusion criteria. The intraoperative information (operation
time and blood loss), length of hospital stay and survival were
recorded and compared between the two groups.
Statistical analysis
The  SPSS version 17.0 statistical software (Statistical Package
for Social Sciences) (http://www-01.ibm.com/software/
analytics/spss/) was used for the statistical analysis of the
data. Demographic data of the patients were demonstrated
as a number, percentage and mean value. Student’s t‑test was
used for comparison of operation time, intraoperative blood
loss and length of hospital stay. The overall survival was
evaluated by Log‑rank test. Two‑tailed P < 0.05 was deemed
as the statistically significant .
RESULTS
Operation time, blood loss, and hospital stay
For the included 219 early breast cancer cases, 107 subjects
received the breast‑conserving operation, and other 112 cases
received the modified radical mastectomy. The operation
time, intraoperative blood loss and length of hospital stay
were (56.7 ± 14.6) min, (39.2 ± 10.1) ml, (12.1 ± 2.1) day
Table 1: The general information of the two groups
Characters Breast-conserving Modified radical
surgery (n=107) mastectomy (n=112)
Age (years) 42.12±3.60 41.72±3.50
TNM n (%)
I 79 (73.83) 80 (71.43)
IIA 28 (26.17) 32 (28.57)
Tumor diameter (cm) 1.88±0.51 1.87±0.48
TNM=Tumor node metastases
Table 2: The operation time, blood loss and hospital stay
period of the two groups
Group n Operation Blood Hospital
time (min) loss (mL) stay (day)
Breast-conserving 107 56.7±14.6 39.2±10.1 12.1±2.1
Modified radical mastectomy 112 95.6±13.5 79.5±13.6 14.8±3.2
t 17.26 21.34 6.36
P <0.01 <0.01 <0.01
C30
in the breast‑conserving group and (95.6 ± 13.5) min,
(79.5 ± 13.6) ml, (14.8 ± 3.2) day in the modified radical
mastectomy group respectively. The operation time,
intraoperative blood loss and length of hospital stay were
smaller in the breast‑conserving group compared with
modified radical mastectomy group with statistical difference
(P < 0.05) [Table 2].
Prognosis
The follow‑up period range from 5 to 60 months for the two
groups. In the breast‑conserving group, 3 cases of recurrence
and 13 cases of remote metastases were observed with the
recurrence rate and metastases rate of 2.80% and 12.15%,
respectively. In the modified radical mastectomy group,
1 cases of recurrence and 19 cases of remote metastases
were observed with the recurrence rate and metastases rate
of 0.89% and 16.96%, respectively. The 1‑year, 3 years and
5 years survival rate were 95.33%, 87.85%, 85.98% and 95.54%,
86.61%, 83.04% for the breast‑conserving and modified radical
mastectomy group respectively [Table 3]. The overall survival
was compared with Kaplan–Meier curve by using Log‑rank
test for the hazard ratio (HR). And the HR was 0.75 with its
95% confidence interval of 0.38–1.48, which indicated that no
statistical difference of overall survival was existed between
the two groups (P > 0.05) [Figure 1].
DISCUSSION
Breast cancer is one of the malignant tumors that seriously
threaten the health of women. The incidence of the whole
world is statistically increased from 1% to 8%/year.[7] Breast
cancer has become the main cause of death for women in
Europe and the United States.[8,9] The morbidity of breast cancer
in China is relative low compared to the United States. However
in recent years, the incidence is on the raise.[10,11]
With a rising diagnostic rate of breast cancer in early stage, and a
progress of comprehensive treatment modality, BCS is considered
to be an appropriate treatment for patients with stage I or II
100 Breast conserving
Modified radical mastectomy
90
Percent survival
80
70
60
0 20 40 60
months
Figure 1: The Kaplan‑Meier curve for evaluation of overall survival
Journal of Cancer Research and Therapeutics - Volume 11 - Special Issue 1- 2015
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Chen, et al.: Breast-conserving surgery for breast cancer

Table 3: The prognosis comparison between the two groups

Group n Recurrence Metastases Survival (%)
(%) (%) 1-year 3 years 5 years
Breast-conserving 107 3 (2.80) 13 (12.15) 95.33 87.85 85.98
Modified radical mastectomy 112 1 (0.89) 19 (16.96) 95.54 86.61 83.04

disease.[12] For most women with early stage breast cancer, BCS Conflicts of interest
is as effective as mastectomy. Survival rates of women treated There are no conflicts of interest.
with BCS and mastectomy were not significant different. But
BCS is not suitable for all women with breast cancer. REFERENCES

In this retrospective study, we compared the clinical efficacy
and prognosis of two operation procedure ‑ BCS and modified
radical mastectomy‑in the treatment of early stage breast
cancer. In this study, we found that the operation time,
intraoperative blood loss and length of hospital stay were
smaller in breast‑conserving group than that of modified
radical mastectomy group. This result indicated the BCS was
less invasive compared to the modified radical mastectomy.
The length of hospital stay was also shorter in BCS compared
to modified radical mastectomy. But, the overall survival for
the two groups was not statistical different indicating the BCS
not inferior to modified radical mastectomy in the aspect of
prognosis.
CONCLUSION
BCS was effective in the treatment of early stage breast
cancer with less operation time and intraoperative blood
and shorter length of hospital stay compared with modified
radical mastectomy. But the results of this study are based on
retrospective data which was easily affected by some bias.
Hence, prospective randomized controlled trials need for
further evaluation the two operation procedures.
Financial support and sponsorship
This study was supported by Quzhou science and technology
project (No. 20051124).
1. Chen W, Zheng R, Zhang S, Zeng H, Fan Y, Qiao Y, et al. Esophageal
cancer incidence and mortality in China, 2010. Thorac Cancer
2014;5:343‑8.
2. Halverson KJ, Taylor ME, Perez CA, Myerson R, Philpott G, Simpson JR,
et al. Survival following breast‑conserving surgery and irradiation or
modified radical mastectomy in patients with invasive breast cancers
with a maximum diameter of 1 cm. Mo Med 1993;90:759‑63.
3. Halsted CP, Benson JR, Jatoi I. A historical account of breast cancer
surgery: Beware of local recurrence but be not radical. Future Oncol
2014;10:1649‑57.
4. Delpech Y, Barranger E. Breast cancer surgery. Rev Prat 2013;63:1395‑9.
5. van de Water W, Bastiaannet E, Scholten AN, Kiderlen M, de Craen AJ,
Westendorp RG, et al. Breast‑conserving surgery with or without
radiotherapy in older breast patients with early stage breast
cancer: A systematic review and meta‑analysis. Ann Surg Oncol
2014;21:786‑94.
6. Boxer MM, Delaney GP, Chua BH. A review of the management of
ductal carcinoma in situ following breast conserving surgery. Breast
2013;22:1019‑25.
7. Siegel R, Naishadham D, Jemal A. Cancer statistics for Hispanics/Latinos,
2012. CA Cancer J Clin 2012;62:283‑98.
8. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin
2015;65:5‑29.
9. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J
Clin 2014;64:9‑29.
10. Fan L, Strasser‑Weippl K, Li JJ, St Louis J, Finkelstein DM, Yu KD, et al.
Breast cancer in China. Lancet Oncol 2014;15:e279‑89.
11. Hong W, Dong E. The past, present and future of breast cancer
research in China. Cancer Lett 2014;351:1‑5.
12. Borgen PI, Heerdt AS, Moore MP, Petrek JA. Breast conservation
therapy for invasive carcinoma of the breast. Curr Probl Surg
1995;32:191‑248.

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