Abstract 163P
Background
There is conflicting data that breast conservative surgery (BCS) is associated with higher locoregional recurrences (LRR) than mastectomy in young breast cancer patients (BCY). However, there is little data from the African population.
Methods
Women aged ≤40 with stage I-III BC, diagnosed in 2008 - 2017 in two Alexandria centres, Egypt, were retrospectively reviewed. We compared the clinicopathological characteristics, treatment, LRR and local recurrence-free survival (LRFS) between patients who underwent mastectomy vs BCS.
Results
Out of the nine hundred and twenty patients included in this analysis, 33% (307) underwent BCS. The mean age at diagnosis was 35.15 years (SD ± 4.3) and was similar in both groups. The table summarises the clinicopathological characteristics of the mastectomy and BCS group. The patients who underwent mastectomy had significantly more T3/T4 tumours and positive lymph nodes (N+), while those who underwent BCS had more grade 3 tumours. The receptor expression (ER, PR, HER2), Ki-67 and the timing of chemotherapy were comparable across the groups. All the BCS patients were irradiated, whereas, in the mastectomy group, T3/T4 and/or N+ patients were irradiated. After a median follow up of 41 months (Range: 1-143), the LRR was similar in both groups: 10% (61) in the mastectomy group and 12% (38) in the BCS group; p=0.263. There was no significant difference in the mean LRFS between the two groups, 124 vs 112 months in mastectomy and BCS groups, respectively; HR 0.835 (95% CI: 0.557 – 1.253, p=0.383). Table: 163P
Clinicopathological characteristics and treatment of the mastectomy vs BCS
| Variable | Mastectomy | BCS | P value | ||
| n | % | n | % | ||
| T-size (n=848)T1/T2T3/T4 | 422139 | 75.224.8 | 26522 | 92.37.7 | <0.001 |
| N-status (n=881)N0N+ 1-3N+ ≥4 | 146162278 | 24.927.647.4 | 1349269 | 45.5 31.2 23.4 | <0.001 |
| Focality (n=902)UnifocalMultifocal | 464136 | 77.322.7 | 25052 | 82.8 17.2 | 0.57 |
| Molecular subtype (n=855)ER/PR positiveHER2 enrichedTNBC | 4643956 | 83.07.010 | 2351744 | 79.45.714.9 | 0.098 |
| Ki-67 (n=143)<20≥20 | 2743 | 38.664.4 | 2449 | 32.9 67.1 | 0.477 |
| Tumour Grade (n=855)IIIIII | 1246491 | 2.181.816.0 | 1220373 | 4.270.5 25.3 | 0.001 |
| Chemotherapy Timing (n=886)NAC onlyAdjuvant OnlyBoth | 3951645 | 6.586.07.5 | 2224915 | 7.787.15.2 | 0.391 |
| BRCA status | Unknown | Not done | Unknown | Not done | N/A |
Conclusions
To our knowledge, this is one of the largest studies of young breast cancer patients in Africa comparing the local failure after mastectomy and BCS. In this large study, breast-conserving surgery was not detrimental to locoregional control in young African breast cancer patients and should be considered whenever feasible and discussed with patients for a joint decision.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.