Breast Conservative Surgery Versus Modified Radical Mastectomy For Elderly Patients With Breast Cancer: A Systemic Review

Objective:To evaluate the efficacy and safety of breast conservative surgery (BCS), compared with modified radical mastectomy (MRM) for elderly patients with breast cancer.Methods:We searched the Cochrane Library (Issue 1,2009), MEDLINE (PubMed 1965～2009.5.2), Embase (1974～2009.5.2), CBM-disc (1978～2009.5.2) and CNKI (1979～2009.5.2), included all of the clinical controlled trials comparing BCS with MRM in the management of elderly patients with breast cancer, extracted the data, assessed the quality and analysed the reslults for the included studies. For survival, mortality, loco-regional relapse rate and distant metastasis rate, we used relative risks (RR), and 95% confidence intervals (CI) for analysis, applying fixed effective model, Review Manager software 5.0. For quality of life (QOL), we used qualitative analysis.Main Results:Six studies were finally included. Two of the six studies were for survival, mortality, loco-regional relapse rate and distant metastasis rate, one was randomized controlled trial (RCT), the other was quasi-RCT, involving 343 patients together. Other four studies were for QOL, one of the four studies was RCT, another was prospective cohort study, and the remaining two were retrospective analysis. For survival, mortality, loco-regional relapse rate and distant metastasis rate at 5 years, they had no statistical significance. The mortality and distant metastasis rate at 10 years of BCS were lower than MRM, they had statistical significance. However, for survival, loco-regional relapse rate at 10 years, it had no statistical significance. And for QOL, the outment of BCS was prior to MRM.Authors' Conclusions:BCS should be a superior option for elderly patients with solitary breast cancer staged T1,T2,T3a,No,Nia,N1b,Mo, who were enable to tolerate both BCS and MRM. The trails available for this SR are limited, which exposes the need for implementation of high quality RCTs regarding elderly patients with breast cancer treated with BCS and MRM, to further confirm the conclusion of this systematic review (SR).