The reciprocal influences of prognosis between two types of surgical interventions and early breast cancer patients with diverse luminal subtypes: A meta-analysis

BACKGROUND: To investigate and compare the effects of breast-conserving therapy (BCT) and mastectomy on the disease recurrence and long-term survival in early-stage luminal breast cancer and the difference in prognosis across diverse luminal subtypes receiving single surgical modality. METHODS: The databases of PubMed and Embase were retrieved to select eligible trials that were published from inception to 13 November 2018. The clinical trials that offered the details about recurrent disease and/or survival in luminal tumors underwent BCT or mastectomy met the inclusion criteria (n=24). With the random- or fixed-effect model basing on heterogeneity Chi(2) test with its significant level of P < .1, pooled odds ratio (OR) with its 95% CI, and P value were identified for endpoints. RESULTS: The analyzed data were constituted of 25 qualified trials with 13,032 unique women suffered from luminal cancers. The fixed-effect models were utilized. On the LRR regarding BCT versus mastectomy, the pooled data indicated no significant difference in luminal carcinomas (OR, 0.84; 95%CI, 0.43–1.64; P = .61; n = 867). In BCT cohort, the pooled data showed that there were some significant benefits favoring luminal A over luminal B in LR (OR, 0.61; 95%CI, 0.46–0.81; P = .0007; n = 5406), DM (OR, 0.53; 95%CI, 0.41–0.69; P < .00001; n = 4662), DFS (OR, 0.59; 95%CI, 0.36–0.96; P = .03; n = 776) and OS (OR, 0.65; 95%CI, 0.42–0.99; P = .05; n = 1149), but not in LRR (OR, 0.74; 95%CI, 0.48–1.13; P = .16; n = 3732), coupled with luminal A/B over luminal-HER2 in LRR (OR, 0.43; 95%CI, 0.25–0.76; P = .004; n = 890), DM (OR, 0.56; 95%CI, 0.35–0.90; P = .02; n = 1396), DFS (OR, 0.47; 95%CI, 0.27–0.83; P = .009; n = 532); in mastectomy cohort, there were apparent advantages of LRR (OR, 0.58; 95%CI, 0.36–0.92; P = .02; n = 1768), LR (OR,0.56; 95%CI, 0.38–0.83; P = .004; n = 1209), DM (OR, 0.58; 95%CI, 0.40–0.84; P = .004; n = 652) and OS (OR, 0.62; 95%CI, 0.43–0.89; P = .009; n = 652) in luminal A vs luminal B. CONCLUSION: For early luminal breast cancer, the equality of LRR was achieved in BCT and mastectomy. In comparison, luminal A cancers benefit the most improved tumor re-appearence and survival in luminal diseases regardless of the option of surgical modality, whereas luminal-HER2 is affected by the worst clinical outcomes in them who follows BCT.