title: Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival.
abstract: BACKGROUND
  The randomized trials comparing breast-conserving therapy (BCT), i.e., surgery and radiation to the breast, with mastectomy in early-stage breast cancer use a variety of protocols. Meta-analysis may assist in understanding the impact of these differences on survival.
  
  
  OBJECTIVE
  To evaluate the possible variations of the relative efficacy of BCT and mastectomy in terms of overall survival according to tumor size, nodal status, and use of adjuvant radiation therapy.
  
  
  METHODS
  The most recent published results and, where available, updated patient-level data from randomized controlled trials of BCT and mastectomy for early-stage breast cancer were combined in a meta-analysis using a random effects model. Pooled survival rates and odds ratios were generated according to subgroups of nodal status and tumor size. Five- and 10-year odds ratios were also determined according to adjuvant radiation protocol.
  
  
  RESULTS
  The pooled odds ratio comparing 10-year survival for BCT and mastectomy was 0.91. The odds ratios comparing the two treatment regimens were not significant after grouping according to tumor size and nodal status. When more than 50% of node-positive patients in both the mastectomy and BCT arms received adjuvant radiation, both arms had similar survival rates. When less than 50% of node-positive patients in both arms received adjuvant nodal radiation, the odds ratio was 0.69, and patients receiving BCT had a survival advantage.
  
  
  CONCLUSIONS
  Patients allocated to BCT have survival rates at least as high as patients allocated to mastectomy. When all protocols were combined, nodal status and tumor size did not significantly alter the relative survival rates. However, under some conditions, particularly for node-positive patients, BCT may confer a relative survival advantage over mastectomy. In particular, mastectomy without adjuvant radiation appears to be inferior to BCT for node-positive patients.
authors.affiliation: Department of Radiation Oncology, Massachusetts, General Hospital, Boston 02114-2617, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Morris
authors.forename: R D
authors.initials: RD
authors.lastname: Morris
authors.forename: J F
authors.initials: JF
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Steinberg
authors.forename: P
authors.initials: P
authors.lastname: Okunieff
authors.forename: R
authors.initials: R
authors.lastname: Arriagada
authors.forename: M G
authors.initials: MG
authors.lastname: Lê
authors.forename: M
authors.initials: M
authors.lastname: Blichert-Toft
authors.forename: J A
authors.initials: JA
authors.lastname: van Dongen
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003710:Demography; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis