Report in English with a Dutch summary (KCE reports 63A)

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72 Breast Cancer KCE reports 63 Surgery for invasive breast cancer. Study ID Ref Search date Hind D et al [163] 2003 Women aged 70 years or over with early breast cancer and who are fit for surgery Jatoi I 2005 [72] NA Women with primary breast cancer Population Intervention Outcomes Results Comments Study type Primary endocrine therapy (PET) vs. surgery Mastectomy and axillary dissection (MT) versus breast-conserving surgery, axillary dissection, and breast radiotherapy (BCT) Poggi M 2003 [164] NA Stage I and II Mastectomy (MT) versus breast conservation therapy (BCT) Fentiman I 2003 [165] NA Women aged 70 years or over with operable breast cancer (T1 T2 T3a, N0 N1a N1b, M0) Modified radical mastectomy (MRM) (n=120) or wide local excision (WLE) and tamoxifen (T) 20 mg daily (n=116) Overall survival Progression-free survival Adverse events Locoregional recurrence Mortality Overall survival Disease-free survival Primary outcome: survival Overall survival: surgery alone vs. PET: HR 0.98 (95% CI 0.74 – 1.30, p 0.9) surgery + ET vs. PET: HR 0.86 (95% CI 0.73 – 1.00, p 0.06) Progression-free survival: surgery alone vs. PET: HR 0.55 (95% CI 0.39 – 0.77, p 0.0006) surgery + ET vs. PET: HR 0.65 (95% CI 0.53 – 0.81, p 0.0001) Four of the 6 trials show that MT significantly reduces the risk of locoregional recurrence when compared with BCT, and the pooled odds ratio also shows a significant benefit for MT (OR 1.56; 95%CI 1.29-1.89; P < 0.001). However, only 1 trial shows a statistically significant benefit for MT in reducing mortality, and the pooled odds ratio shows no significant difference between MT and BCT (OR, 1.07; 95%CI, 0.94- 1.22; P = 0.33). Overall survival: 58% for MT vs. 54% for BCT (p = 0.67) Disease-free survival: 67% for MT vs. 63% for BCT (p = 0.64) No difference in progression-free survival Significantly more loco-regional relapses in the WLE+T group More distant metastases in the MRM group, but with a similar overall survival in both groups 7 RCTs SR High Pooled analysis of 6 RCTs MA High Mean follow-up of 18.4 years RCT High RCT High Level of evidence
KCE reports 63 Breast Cancer 73 Study ID Ref Search date Arriagada R 2003 [166] NA Women with breast cancer measuring
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