Multi-center Real-World Analysis of Breast-Conserving Surgery versus Mastectomy for Early-Stage Breast Cancer in China (the decade 2013-2022)

Background Breast cancer remains one of the most common malignancies globally. With advancements in systemic therapies and radiation, breast-conserving surgery (BCS) has emerged as a preferred option for early-stage breast cancer. However, real-world studies comparing BCS and mastectomy outcomes, especially in China, are limited, necessitating further exploration of patient selection, survival outcomes, and economic implications. Method A retrospective cohort study was conducted using the National Cancer Center Oncology Information Database (NCCOID) in China, covering 2013 to 2022. Female patients diagnosed with early-stage breast cancer who underwent either BCS or mastectomy were included. Clinical outcomes, causes of death, and medical expenses were analyzed. The primary endpoint was overall survival (OS), and the secondary endpoint was breast cancer-specific survival (BCSS). Statistical analyses included Kaplan-Meier survival curves and Cox regression models. Results This study included 114,094 female breast cancer patients, with 20.6% undergoing BCS and 79.4% for mastectomy. BCS showed higher 5-year OS (97.9% [95% CI 97.7%-98.2%] vs. 95.3% [95% CI 95.1%-95.5%], p < 0.001) and BCSS (99.0% [95% CI 98.9%-99.2%] vs. 97.4% [95% CI 97.2%-97.5%], p < 0.001) than mastectomy. The BCS group was associated with lower mortality from both breast cancer and cardiovascular diseases compared to the mastectomy group, with statistically significant differences observed (p < 0.001). The BCS group incurred higher costs than the mastectomy group across all stages (78,610.63 RMB vs. 68,995.82 RMB, p < 0.001). Conclusion The BCS rate has increased from 2013 to 2022. Patients undergoing BCS have better OS and BCSS than mastectomy despite higher expenses resulting from BCS.