Breast-conserving therapy versus mastectomy: Long-term results from a matched pair analysis

Background: We investigated whether primary mastectomy had any significant effect on overall survival as well as on loco-regional and generalized recurrence as opposed to primary breast-conserving therapy (BCT). Patients and Methods: We matched 1574 patients who were treated for breast cancer with regard to tumor size, nodal involvement, grading, patient age and menopausal status. We applied univariate and multivariate analysis to our data, using Kaplan-Meier analysis, log-rank test and the Cox regression model. The median patient follow-up was 58 months. Results: We did not find that the mode of primary surgery had any significant effect on overall survival, but we found that patients who had no nodal involvement at primary surgery and who had BCT had a significantly increased risk of developing local or regional recurrence. Apart from that, the choice of surgical procedure, if correctly indicated, had no influence on overall survival, loco-regional or generalized recurrence. Conclusion: These data support the existing notion that local management of breast cancer should be accomplished using a limited surgical approach combined with radiotherapy. Further studies are needed to determine the correct indications for radiotherapy within the concept of BCT.