Association of Breast-Conserving Therapy With Measures of Long-term Quality of Life Compared With Mastectomy and Reconstruction
Menée à l'aide de données 2006-2008 du registre des cancers du Texas portant sur 647 patientes atteintes d'un cancer du sein de stade 0-II (âge médian : 53 ans), cette étude compare la qualité de vie des patientes en fonction du traitement chirurgical reçu (chirurgie conservatrice avec radiothérapie ou mastectomie et reconstruction sans radiothérapie)
In their investigation of long-term patient-reported outcomes after surgical treatment of early-stage breast cancer, Hanson et al reported equivalent patient satisfaction with breasts and physical well-being but better psychosocial and sexual well-being in patients who underwent breast-conserving surgery with subsequent radiation therapy (RT) compared with patients who underwent mastectomy and reconstruction. Given that more women eligible for breast-conserving surgery are choosing to undergo mastectomy, these findings have important implications for those patients’ decisions.The association of mastectomy with diminished quality-of-life (QOL) outcomes compared with breast-conserving surgery has been widely reported. However, most prior studies included patients undergoing breast-conserving surgery without RT, patients undergoing mastectomy without reconstruction, and patients undergoing mastectomy with RT. The study by Hanson et al directly compared breast-conserving surgery with RT vs mastectomy and reconstruction without RT to avoid those potential confounders. One area not explored by Hanson et al is how breast-conserving surgery and mastectomy impact postoperative patient-reported outcomes compared with the preoperative baseline. Huynh et al reported that patients undergoing breast-conserving surgery are significantly more likely than patients undergoing mastectomy to return to or exceed their preoperative baseline patient-reported outcome scores. Overall, the preponderance of evidence suggests superior short-term and long-term patient-reported outcomes in patients with early-stage breast cancer undergoing breast-conserving surgery compared with mastectomy.
JAMA Surgery 2022