Breast Conservation Therapy vs. Mastectomy Survival in Young Breast Cancer Patients: Systematic Review and Meta-Analysis.

BACKGROUND

While young breast cancer patients exhibit lower overall survival (OS) than older groups, it remains unclear whether OS differs between breast-conserving therapy (BCT) and mastectomy specifically in this younger population. Although BCT carries a higher recurrence risk than mastectomy in young patients, OS appears similar across all ages. This meta-analysis therefore directly compares OS and breast cancer specific survival (BCSS) in young patients treated with BCT versus mastectomy.

METHODS

Our review included 6 studies that compared OS between BCT and mastectomy in patients aged 40 years or younger diagnosed with stage I-III breast cancer. The endpoint was OS/BCSS, and only studies presenting hazard ratios (HRs) were included in the analysis. Meta-analyses used inverse-variance random effects (REML with Hartung-Knapp confidence intervals [CIs]); heterogeneity was assessed with Q and I 2. Leave-one-out, fixed-effect, and DerSimonian-Laird models tested robustness; Egger's test explored small-study effects. Analyses were performed in RevMan 5.3 and Stata 17, with p < 0.05 or 95% CIs excluding 1.00 considered significant.

RESULTS

OS showed no difference between BCT and mastectomy (pooled HR = 0.99, 95% CI: 0.88-1.10, I 2 = 54%). BCSS favored BCT with a small but significant reduction in mortality (HR 0.92, 95% CI: 0.86-0.98, I 2 = 0%). Subgroup analyses of OS suggested stage dependence: benefit with T1-2 (HR 0.93, 0.87-0.99) and N0-1 (HR 0.93, 0.87-0.99), but no advantage in T1-3 or N2-3 disease (both HR 1.19, 0.99-1.44). Leave-one-out and model checks did not change inference; unadjusted estimates suggested benefit but this attenuated after adjustment.

CONCLUSION

In women ≤40 years with stage I-III breast cancer, BCT with radiotherapy achieves OS comparable to mastectomy and may yield a modest BCSS benefit, particularly in lower-burden disease (T1-2 or N0-1). Given the observational nature of the evidence and residual heterogeneity, results should be interpreted cautiously and individualized clinical decision-making is recommended; randomized or prospectively adjusted data are still needed.