Oncologic outcomes of central quadrantectomy versus total mastectomy in early-stage breast cancer

초록

Background: While total mastectomy has long been the standard treatment for centrally located breast cancer, recent studies have shown that breast-conserving surgery, such as central quadrantectomy, can offer comparable oncologic safety. This study aims to compare the long-term oncologic outcomes of central quadrantectomy versus total mastectomy in patients with early-stage breast cancer. Material and methods: We conducted a retrospective study using data from Korea University Guro Hospital. Patients diagnosed with early-stage breast cancer who underwent either central quadrantectomy or total mastectomy between 2010 and 2024 were included. Patients with advanced breast cancer, sarcoma, phyllodes tumor or those who received neoadjuvant chemotherapy were excluded. Clinicopathological variables were compared using the Chi-square test. Cox regression was used for univariable and multivariable analysis to identify predictors of oncologic outcomes. Kaplan-Meier analysis was performed for survival and locoregional recurrence. Results: Patients who underwent central quadrantectomy (n=23) were compared with those who underwent total mastectomy (n=317). The locoregional recurrence rate was 8.7% in the central quadrantectomy group and 5.4% in the total mastectomy group (p = 0.502), showing no statistically significant difference. Additionally, the association between NAC resection and locoregional recurrence within the total mastectomy group was not significant (p = 0.496). Overall survival and locoregional recurrence between the two groups also showed no significant differences (p = 0.433 and p = 0.861, respectively). Conclusions: Central quadrantectomy offers comparable oncologic outcomes to total mastectomy in patients with early-stage breast cancer. Therefore, central quadrantectomy may be considered an oncologically safe surgical option for patients with early breast cancer. Furthermore, it is essential that the extent of cancer involvement and even cosmetic aspects are thoroughly explained to the patient, enabling a shared decision-making process when selecting the surgical approach.