Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis
Introduction: Locally advanced breast cancer (LABC) accounts for 5 % of new breast cancer diagnoses in developed countries and 30–60 % in developing regions. Historically, treatment relied on mastectomy guided by the Halstedian theory. Advances in neoadjuvant chemotherapy (NACT), breast-conserving s...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-02-01
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| Series: | Breast |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977624002005 |
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| author | Megan Chua Wern Ee Ashley Lee Shi Hui Wong Hung Chew Emmeline Elaine Cua-Delos Santos Sean Li Siwei Sng Ming Xian Qin Xiang Ng Serene Goh Si Ning |
| author_facet | Megan Chua Wern Ee Ashley Lee Shi Hui Wong Hung Chew Emmeline Elaine Cua-Delos Santos Sean Li Siwei Sng Ming Xian Qin Xiang Ng Serene Goh Si Ning |
| author_sort | Megan Chua Wern Ee |
| collection | DOAJ |
| description | Introduction: Locally advanced breast cancer (LABC) accounts for 5 % of new breast cancer diagnoses in developed countries and 30–60 % in developing regions. Historically, treatment relied on mastectomy guided by the Halstedian theory. Advances in neoadjuvant chemotherapy (NACT), breast-conserving surgery (BCS), and radiation have transformed treatment into a multimodal approach. Extreme oncoplastic BCS (eOPBCS) has expanded the boundaries of BCS, enabling large-volume resections with breast reshaping. However, its oncologic outcomes compared to mastectomy remain unclear, particularly in LABC. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO: CRD42024535182). Studies involving eOPBCS for LABC were reviewed, and those comparing outcomes with mastectomy were included in the meta-analysis. The primary outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence rates (LRR). Data were synthesized using a random-effects model. Results: Of 866 identified studies, 33 were included in the systematic review and 4 in the meta-analysis, involving 2902 patients with LABC. Among them, 16.1 % underwent eOPBCS. Patients receiving eOPBCS were younger, had larger tumours, and more frequently underwent axillary clearance. The pooled hazard ratio (HR) for OS comparing mastectomy to eOPBCS was 1.72 (95% CI 1.04-2.83). Meanwhile, HRs for DFS (1.11, 95% CI 0.60-2.08) and LRR (0.67, 95% CI 0.38-1.18) showed that there were no statistically significant differences but a trend toward lower recurrence rates with mastectomy. Conclusion: eOPBCS demonstrates comparable to superior oncological outcomes to mastectomy in LABC, offering a promising option for selected patients. However, slightly elevated local recurrence rates, though not statistically significant, highlight the importance of careful patient selection and further research. High-quality prospective studies are essential to validate these findings and refine criteria for incorporating eOPBCS into routine clinical practice. |
| format | Article |
| id | doaj-art-96918d8aecb14e57b307e462b9001b0f |
| institution | Kabale University |
| issn | 1532-3080 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj-art-96918d8aecb14e57b307e462b9001b0f2025-02-12T05:30:37ZengElsevierBreast1532-30802025-02-0179103869Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysisMegan Chua Wern Ee0Ashley Lee Shi Hui1Wong Hung Chew2Emmeline Elaine Cua-Delos Santos3Sean Li Siwei4Sng Ming Xian5Qin Xiang Ng6Serene Goh Si Ning7Yong Yoo Lin School of Medicine, National University of Singapore, SingaporeYong Yoo Lin School of Medicine, National University of Singapore, SingaporeResearch Support Unit, NUS Yong Loo Lin School of Medicine, National University of Singapore, SingaporeDepartment of General Surgery, Breast Division, National University Health System, SingaporeLee Kong Chian School of Medicine, Nanyang Technological University (NTU), SingaporeLee Kong Chian School of Medicine, Nanyang Technological University (NTU), SingaporeSaw Swee Hock School of Public Health, National University of Singapore, SingaporeYong Yoo Lin School of Medicine, National University of Singapore, Singapore; Department of General Surgery, Breast Division, National University Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Cancer Institute of Singapore, Singapore; Corresponding author. Associate Consultant Department. Department of General Surgery, Breast division, National University Hospital, 5 Lower Kent Ridge Road Singapore 119074, Singapore.Introduction: Locally advanced breast cancer (LABC) accounts for 5 % of new breast cancer diagnoses in developed countries and 30–60 % in developing regions. Historically, treatment relied on mastectomy guided by the Halstedian theory. Advances in neoadjuvant chemotherapy (NACT), breast-conserving surgery (BCS), and radiation have transformed treatment into a multimodal approach. Extreme oncoplastic BCS (eOPBCS) has expanded the boundaries of BCS, enabling large-volume resections with breast reshaping. However, its oncologic outcomes compared to mastectomy remain unclear, particularly in LABC. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO: CRD42024535182). Studies involving eOPBCS for LABC were reviewed, and those comparing outcomes with mastectomy were included in the meta-analysis. The primary outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence rates (LRR). Data were synthesized using a random-effects model. Results: Of 866 identified studies, 33 were included in the systematic review and 4 in the meta-analysis, involving 2902 patients with LABC. Among them, 16.1 % underwent eOPBCS. Patients receiving eOPBCS were younger, had larger tumours, and more frequently underwent axillary clearance. The pooled hazard ratio (HR) for OS comparing mastectomy to eOPBCS was 1.72 (95% CI 1.04-2.83). Meanwhile, HRs for DFS (1.11, 95% CI 0.60-2.08) and LRR (0.67, 95% CI 0.38-1.18) showed that there were no statistically significant differences but a trend toward lower recurrence rates with mastectomy. Conclusion: eOPBCS demonstrates comparable to superior oncological outcomes to mastectomy in LABC, offering a promising option for selected patients. However, slightly elevated local recurrence rates, though not statistically significant, highlight the importance of careful patient selection and further research. High-quality prospective studies are essential to validate these findings and refine criteria for incorporating eOPBCS into routine clinical practice.http://www.sciencedirect.com/science/article/pii/S0960977624002005 |
| spellingShingle | Megan Chua Wern Ee Ashley Lee Shi Hui Wong Hung Chew Emmeline Elaine Cua-Delos Santos Sean Li Siwei Sng Ming Xian Qin Xiang Ng Serene Goh Si Ning Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis Breast |
| title | Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis |
| title_full | Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis |
| title_fullStr | Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis |
| title_full_unstemmed | Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis |
| title_short | Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis |
| title_sort | oncological outcomes following extreme oncoplastic breast conserving surgery eopbcs for locally advanced breast cancer labc a systematic review and meta analysis |
| url | http://www.sciencedirect.com/science/article/pii/S0960977624002005 |
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