Abstract
Background: Recent clinical trials comparing local recurrence rates in young breast cancer(BC) patients after breast-conserving therapy (BCT) vs. mastectomy are scarce. This meta-analysis aims to determine the optimal surgical approach for this group by assessing local recurrence (LR) rates between BCT and mastectomy.
Methods: We systematically searched four electronic databases (Medline, PubMed, Cochrane Library, and Web of Science) for relevant studies comparing LR rates in BC patients ≤40 years old treated with BCT plus radiotherapy or mastectomy. Studies meeting the inclusion criteria were synthesized using a random-effects model, with a focus on LR rates. We conducted sensitivity analyses and meta-regression to assess publication bias and heterogeneity, ensuring a rigorous evaluation of the available evidence.
Results: Out of 485 screened citations, 11 studies encompassing 9215 patients were included, with 4190 undergoing BCT and 5025 undergoing mastectomy. The summary OR revealed a significantly higher risk of LR for BCT compared to mastectomy among young breast cancer patients (OR = 1.63; 95% CI: 1.25-2.13). Specifically, the BCT group exhibited a higher 5-year LR rate (OR = 1.86, 95% CI: 1.13-2.62) and a 5-10-year LR rate (OR = 1.50, 95% CI: 1.00-2.25) compared to the mastectomy group. This trend held true across tumor stages, with the BCT group showing increased LR risk for both T1-2 (OR = 1.88, 95% CI: 1.20-2.94) and T1-4 (OR = 1.46, 95% CI: 1.02-2.10) stages. Similarly, nodal status analysis indicated a higher LR risk for BCT in N0-1 (OR = 2.56, 95% CI: 1.90-3.44) and N0-3 (OR = 1.38, 95% CI: 0.99-1.93) stages. Notably, among very young women (age ≤ 35), the difference in LR rate between BCT and mastectomy was pronounced (OR = 2.04, 95% CI: 1.48-2.81). Overall, for breast cancer patients aged ≤ 40 years, the BCT group consistently demonstrated a higher risk of LR compared to the mastectomy group (OR = 1.53, 95% CI: 1.10-2.13).
Conclusion: Our meta-analysis revealed that among young breast cancer patients, BCT was associated with a significantly elevated risk of LR compared to mastectomy, particularly in those ≤35 years old. This heightened risk persisted across various tumor and nodal stages. For very young breast cancer patients, a comprehensive consideration of surgical options is warranted, with caution exercised in selecting BCT. While overall survival (OS) rates were comparable between the two groups in young women, further research is warranted to elucidate these findings and guide clinical decision-making. [1-3]