Should young age be a contra-indication to breast conservation treatment in Chinese women? Twelve-year experience from a public cancer centre in Hong Kong

Abstract

Objective: It has been proposed that young women should not be treated by breast conservation treatment because of a higher risk of local recurrences and worse survival. We therefore examined whether breast conservation treatment in young Chinese women yielded inferior clinical outcomes compared to modified radical mastectomy. Design: Retrospective study. Setting: Clinical oncology department in a public hospital in Hong Kong. Patients: A total of 258 Chinese women with invasive breast cancer, aged below 40 years, and referred between January 1994 and July 2006. Results: A total of 124 (48%) and 134 (52%) patients were treated by breast conservation treatment and modified radical mastectomy, respectively. Mastectomy patients tended to have larger primary tumours (P<0.001) and more nodal involvement (P<0.001). At a median follow-up of 6.5 years, there was no significant difference in the local failure-free survival rate (92% vs 93%, P=0.324) and loco-regional failure-free survival rate (89% vs 88%, P=0.721) in patients having breast conservation treatment and mastectomy. Probably due to their earlier presentation with disease, the former actually had better 6-year distant failure-free survival (88% vs 71%, P=0.002) and overall survival (92% vs 81%, P=0.173) rates. Multivariate analyses showed that both the resection margin status (hazard ratio=2.77, P=0.050) and the presence of peritumoural vascular invasion (hazard ratio=3.01, P=0.038) were independent predictors of local recurrence; the nodal status (hazard ratio=3.91, P<0.001) was the only predictive factor for overall survival. The choice of breast conservation treatment (vs modified radical mastectomy) had no apparent adverse impact on all the clinical outcome parameters analysed. Conclusion: Breast conservation treatment is a reasonable option for many suitably selected young Chinese women.

目的 由於較高復發率及較低生存率，過往一直認為患有乳癌的年輕女性不應接受保乳治療。本研究探討患有乳癌的年輕女性中，接受保乳治療的與接受改良根治性乳房切除術的比較，前者是否有較差的臨床結果。 設計 回顧研究。 安排 香港一所公營醫院的臨床腫瘤部門。 患者 1994年1月至2006年7月期間，獲轉介的258名患有侵犯性乳癌、40歲以下的華籍女性。 結果 124名（48%）病人接受保乳治療，另134名（52%）接受改良根治性乳房切除術。接受乳房切除術的病人通常有較大的原發性腫瘤（P< 0.001）及較多淋巴結轉移（P< 0.001）。中位數為6.5年的隨訪期間，保乳治療及乳房切除術兩組病人在無局部復發生存率（92%比93%；P=0.324）及無局部區域復發生存率方面（89%比88%；P=0.721）皆沒有顯著差別。可能由於接受保乳治療的病人大多於早期確診，她們的6年無遠處轉移生存率（88% vs 71%；P=0.002）及總生存率（92% vs 81%；P=0.173）較佳。多因素分析顯示環周切緣情況（風險比=2.77；P=0.050）和腫瘤周血管侵犯（風險比=3.01；P=0.038）是局部復發的獨立預測因素。淋巴結轉移（風險比=3.91；P< 0.001）是總生存率的唯一預測因素。與改良根治性乳房切除術比較，保乳治療於本研究的臨床結果並無負面影響。 結論 對於很多經篩選患有乳癌的年輕女性來說，保乳治療是一個適切的選擇。