Winters, Z;
Horsnell, J;
Elvers, K;
Maxwell, A;
Jones, LJ;
Shaaban, AM;
Schmid, P;
... Brunt, AM; + view all
(2018)
Systematic Review of impact of BCS on cancer outcomes
in Multiple Ipsilateral Breast Cancers (MIBC) - rationale for MIAMI randomised trial.
Presented at: Association of Breast Surgery Annual Scientific Meeting, Birmingham, UK.
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Abstract
Background: Clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast-conserving surgery (BCS) compared to the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and inter-tumoural heterogeneity. This novel systematic review’s primary aim(s) were to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers defined as MIBC. Methods: Electronic searches identified English language papers (May 1988-July 2015) evaluated for study quality using the Newcastle-Ottowa Score (NOS): >7 stars -‘high’, 4-6 stars -‘moderate’ and remainder - ‘poor’. Results: All 24 studies were retrospective: 17 comparative and 7 case-series (n=3537 women with MIBC undergoing BCS: 2677 were defined as MF; 292 as MC; and 568 as MIBC). 6/7 studies evaluated MIBC treated by BCS or mastectomy with local recurrence (LR) rates of 3-23% (median follow-up (FU) 60-months, IQR: 56-81). Types of surgery showed apparently equivalent rates of LR (RR 0.96, 95% CI 0.65; 1.40). 13 studies compared BCS in MIBC to unifocal cancers reporting LR rates of 2-40% (median FU 64-months, IQR: 57-73). One high quality study reported 10-year actuarial LR rates of 5.5% versus 6.5% for BCS (n=300) and mastectomy (n=887). Conclusions: ‘Moderate’ quality studies were: historical, underpowered, with limited follow-up, and biased case-selection favouring BCS for low-risk patients versus mastectomy. Evidence is inconclusive regarding the primary aims, precluding meta-analyses and weakening support for the latest St Gallen consensus. Future trials should aim to evaluate 10-year LR with inter-study comparisons of patient numbers exceeding those reported: producing the first randomised trial called MIAMI.
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