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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Article info
Publication history
Published online: June 21, 2017
Accepted:
May 17,
2017
Received in revised form:
April 19,
2017
Received:
January 16,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
