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Survival outcomes of patients with lobular carcinoma in situ who underwent bilateral mastectomy or partial mastectomy

  • Author Footnotes
    1 Authors contributed equally to this work.
    Ze-Ming Xie
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Author Footnotes
    1 Authors contributed equally to this work.
    Jian Sun
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    Department of Clinical Research, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Author Footnotes
    1 Authors contributed equally to this work.
    Zhe-Yu Hu
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    Department of Clinical Research, First Hospital of Changsha City, No. 311, Yinpan Road, Changsha, 410005, PR China

    Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States
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  • Yao-Pan Wu
    Affiliations
    Department of Radiology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Peng Liu
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Jun Tang
    Correspondence
    Corresponding author: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China. Fax: +86 20 87343066.
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Xiang-Sheng Xiao
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Wei-Dong Wei
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Xi Wang
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Xiao-Ming Xie
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Ming-Tian Yang
    Affiliations
    Department of Breast Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou, 510060, PR China
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  • Author Footnotes
    1 Authors contributed equally to this work.

      Highlights

      • Survival outcomes of 5964 cases of lobular carcinoma in situ were analysed.
      • 10-year breast cancer-specific estimated survival rates were 99.21%.
      • Prophylactic bilateral mastectomy did not improve survival outcomes.

      Abstract

      Aim

      To compare the survival outcomes between patients treated with bilateral mastectomy and partial mastectomy alone as the initial surgical management for primary lobular carcinoma in situ (LCIS).

      Patients and methods

      Patients with histologically confirmed LCIS underwent partial mastectomy alone or bilateral mastectomy were identified by the SEER*Stat database (version 8.3.2) released in 2016. The primary outcome measure was all-cause mortality and the secondary outcome measure was breast cancer-specific mortality.

      Results

      Of the 5964 cases included in the analysis, 208 cases underwent bilateral mastectomy and 5756 cases underwent partial mastectomy alone. The 1-, 5- and 10-year estimated overall survival rates were 99.7%, 96.7% and 91.7%, respectively. Univariate and multivariate proportional hazards regression (Cox) analyses showed no significant difference between the risk of all-cause mortality in the bilateral mastectomy group compared with the partial mastectomy group (HR = 1.106, 95% confidence interval [CI] 0.350–3.500, P = 0.86). In propensity score-matched model, bilateral mastectomy still did not show benefit to overall mortality (HR = 2.248, 95% CI 0.451–11.200). Patients older than 60 years of age showed a higher risk of all-cause mortality (HR = 7.593, 95% CI 5.357–10.764, P < 0.0001). No risk factors, including surgery type, were identified for breast cancer-specific survival.

      Conclusions

      Survival outcomes of patients with LCIS who underwent partial mastectomy without radiotherapy were not inferior to patients who underwent bilateral prophylactic mastectomy. Breast cancer-specific mortality in patients with LCIS was extremely low; aggressive prophylactic surgery like bilateral prophylactic mastectomy should not be advocated for most patients with LCIS.

      Keywords

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