Med J Indones
Abstrak
Latar belakang: Tujuan penelitian ini adalah untuk membandingkan hasil pengobatan antara penggunaan pengobatan
konservasi payudara (breast conserving therapy, BCT) dan mastektomi pada pasien kanker payudara T1-2N0.
Metode: Penelitian retrospektif ini dilakukan pada pasien kanker payudara T1-2N0 yang menerima pengobatan antara
Januari 2001 dan Desember 2010 di Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo dan Jakarta Breast
Center. Hasil akhir penelitian ini adalah kesintasan (OS), kekambuhan lokal (LR), kanker payudara kontra lateral (CBC),
metastasis jauh (DM), dan disease free survival (DFS).
Hasil: Diantara 262 pasien yang memenuhi kriteria, 200 (76,3%) pasien menjalani BCT sedangkan 62 (23,7%) pasien
menjalani mastektomi. Tidak ada perbedaan antara kelompok BCT dan mastektomi dalam hal kesintasan 5 tahun (5-yearoverall-survival) 5-Y OS (88,2% vs 86,7%, p = 0,743), LR (7,4% vs 2,7%, p = 0,85), CBC (3,4% vs 5,3%, p = 0,906 ), DM
(17,7% vs 37,7%, p = 0,212), dan DFS (78,5% vs 60,7%, p = 0,163). Dalam analisis multivariat, grade 3 dikaitkan dengan
OS lebih buruk (HR 2,79, 95% CI 1,08-7,21, p = 0,03) dan DFS (HR 2,32, 95% CI 1,06-5,06). Wanita premenopause
dikaitkan dengan risiko penurunan DM (HR 0,37, 95% CI 0,17-0,80) dan DFS (HR 0,38, 95% CI 0,19-0,78).
Kesimpulan: BCT dan mastektomi menunjukkan hasil yang sama dalam hal OS, LR, CBC, DM, dan DFS. (Med
J Indones. 2012;21:220-4)
Abstract
Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT)
and mastectomy for T1-2N0 breast cancer patients.
Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January
2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center.
The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant
metastasis (DM), and disease-free survival (DFS).
Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent
mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR
(7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%,
p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 7.21, p = 0.03) and
DFS (HR 2.32; 95% CI 1.06 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI
0.17 0.80) and DFS (HR 0.38; 95% CI 0.19 0.78).
Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS. (Med J
Indones. 2012;21:220-4)
Keywords: Breast-conserving treatment, mastectomy, outcomes
METHODS
RESULTS
BCT
n (%)
Mastectomy
n (%)
40 (20)
160 (80)
3 (4.8)
59 (95.2)
0.006
Age
< 40 years
40 years
Menopause
Pre menopause
Post menopause
121 (61.4)
76 (38.6)
19 (3.6)
43 (69.4)
< 0.001
Site
Right
Left
105 (52.5)
95 (47.5)
34 (54.8)
28 (45.2)
0.747
Tumor Size
T1
T2
56 (28.4)
141 (71.6)
14 (22.6)
48 (77.4)
pN
Negative
Positive
128 (69.2)
57 (30.8)
33 (60)
22 (40)
0.203
Histology
Ductal invasive
163 (81.5)
47 (75.8)
0.326
Margin status
Negative
Close positive
155 (95.1)
8 (4.9)
28 (90.3)
3 (9.7)
0.248
Grade
12
3
117 (82.4)
25 (17.6)
29 (68.3)
13 (31.7)
0.061
LVSI
Positive
21 (70)
14 (73.7)
0.781
ECE
Positive
14 (36.8)
11 (78.6)
0.008
ER
Negative
Positive
94 (52.8)
84 (47.2)
27 (45.8)
32 (54.2)
0.348
PR
Negative
Positive
91 (51.1)
87 (48.9)
30 (51.7)
28 (48.3)
0.937
Her-2
Negative
Positive
111 (63.1)
65 (36.9)
31 (55.4)
25 (44.6)
0.302
Radiation therapy
200 (100)
20 (32.2)
< 0.001
Adjuvant chemotherapy
102 (51)
34 (54.8)
0.597
Hormonal therapy
66 (33)
26 (41.9)
0.198
Trastuzumab
14 (7)
7 (11.5)
0.289
0.366
pN = pathological nodes, LVSI = lymphovascular space invasion, ECE = extra capsular invasion,
ER = estrogen receptor, PR = progesterone receptor
Med J Indones
Years
BCT
Mastectomy
Overall survival
Local recurrence
Contra-lateral
breast cancer
5
5
88.2
7.4
86.7
2.7
0.835
0.850
3.4
5.3
0.906
Distant metastasis
17.7
37.7
0.212
Disease free
5
78.5
60.7
0.163
survival
p value obtained from Kaplan Meier with log-rank test
OS
LR
Recurrences
CBC
DM
DFS
Treatment
BCT
Mastectomy
0.835
0.850
0.906
0.212
0.163
Age
< 40 years
40 years
0.161
0.566
0.527
0316
0.691
Menopause
Pre menopause
Post menopause
0.180
0.583
0.748
0.009
0.006
Tumor size
T2
T1
0.038
0.316
0.183
0.033
0.430
pN
Positive
Negative
0.031
0.797
0.498
0.061
0.241
Margin
Negative
Close-Positive
3
12
Positive
Negative
0.799
0.532
0.672
0.196
0.176
0.003
0.294
0.259
0.038
0.030
0.338
0.515
0.114
0.838
0.705
Grade
LVSI
ER
Negative
Positive
0.134
0.826
0.737
0.922
0.613
PR
Negative
Positive
0.300
0.796
0.253
0.181
0.203
Her-2
Negative
0.250
0.558
0.773
0.295
0.360
Positive
pN = pathological nodes, LVSI = lymphovascular space invasion, ER = estrogen receptor, PR = progesterone receptor
95% CI
2.338
1.634
2.796
0.51 10.65
0.66 4.08
1.08 7.21
0.272
0.293
0.033
0.366
1.524
2.211
0.17 0.80
0.57 4.05
0.95 5.14
0.012
0.398
0.065
0.379
0.19 0.78
0.008
Grade 3 vs 1 2
2.323
1.07 5.06
0.034
Overall survival
T2 vs T1
pN positive vs negative
Grade 3 vs 1 2
Distant metastasis
Pre vs post menopause
T2 vs T1
Grade 3 vs 1 2
Disease free survival
DISCUSSION
During the last thirty years, treatment for early-stage
breast cancer has shifted from mastectomy to BCT.
Between 1980 and 2004, the use of mastectomy at the
Mayo Clinic dropped from 91% to 36%.10 In four of
the nine Dutch Comprehensive Cancer Centers, the
majority of early-stage breast cancer patients received
BCT (87-99%).8 However, in Hong Kong as well as
in Sabah Malaysia, the use of BCT was only 30% and
22.5%, respectively.9,11
BCT is more widely used in patients with younger
age ( 40 years). In the Dutch Comprehensive
Cancer Center, patients with age older than 75 years
are associated with decreased use of radiotherapy
compared to patients younger than 55 years (OR 0.4;
95% CI from 0.4 to 0.5).10 The same result has been
obtained from research in the U.S.A.12
Definitive radiation therapy decreased local recurrence
after lumpectomy from 39.2% to 14.3% in a study
conducted by the NSABP B-06.13 Meta-analysis
conducted by the EBCTCG showed that radiotherapy
after breast-conserving surgery decreased local
recurrence within 5 years and mortality in 15 years by
19% and 5.4%.14
Several studies have shown that breast conserving
therapy and mastectomy provided equivalent survival.
The study from North Carolina showed that mastectomy
and BCT gives the same 5 year-survival-rate (94.8%
and 96.7%, HR 1.33 95% CI 0.86 to 2.05).15 Rapiti
et al reported that the 10 years survival in patients
who underwent BCT and mastectomy did not differ
significantly (HR 0.69; 95% CI 0.46 to 1.03).16 A study
in Korea showed that 10 year overall survival in patients
receiving BCT and mastectomy were 91.96% and
91.01% (p = 0.127).17 EORTC 10.801 study reported
Med J Indones
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