Breast conservation therapy or mastectomy and breast reconstruction in the treatment of locally advanced and/or multifocal/multicentric breast cancer? Systematic review and meta-analysis

Abstract

Objective: The purpose of this systematic review and meta-analysis was to measure if breast conservation therapy (BCT)
was feasible for female patients with multifocal (MF), multicentric (MC), and/or ≥5 cm breast cancer (BC) and compare
the results of treatment with those patients who underwent mastectomy (MT). Methodology: This systematic review and
meta-analysis were recorded at Prospero CRD42022362765 and conducted based on the Prisma checklist. PubMed, Web of
Science, and Virtual Health Library databases were searched in April 2023. Results: A total of eight retrospective cohort
studies were included for evaluation, comprising a total of 2,151 women, of which 838 underwent BCT and 1,313 underwent
MT. The meta-analysis revealed that in the treatment of MF/MC and/or ≥5 cm BC, based on the random-effects model,
there was no significant difference in local relapse (LR) (OR=0.67, 95%CI 0.02–1.37, p=0.61, I²=7.5%), regional recurrence
(RR) (OR= -0.23, 95%CI -1.97 to 1.51, p=0.79, I²=0), metastasis (OR= -0.08, 95%CI -0.76 to 0.60, p=0.813, I²=0), and mortality
(OR= -0.02, 95%CI -1.89 to 1.85, p=0.98, I²=42%) between the BCT and MT groups. The cumulative incidence of LR was 3.2%
(27/838) for BCT and 1.1% (14/1313) for MT. The incidence of RR was 1% in both the BCT and MT groups. The incidence of
metastasis was 6.6% in the BCT (21/316) group and 7.8% (18/229) in the MT group, and the mortality was 4.1% (9/222) in
the BCT group, with a mean follow-up of 65.1 months and 2.5% (3/119) in the MT group with a mean follow-up of 51 months. Conclusion: Our results demonstrated that BCT does not result in inferior local control or worse survival outcomes
for patients with MF/MC and/or ≥5 cm BC and that BCT can be offered when feasible clinically for these patients.