Survival after breast-conserving surgery and radiotherapy versus mastectomy - propensity score analyses within a randomized anaesthesiology trial

Q: What treatments are compared in the study?

The study compares breast-conserving surgery plus adjuvant radiotherapy (BCS+RT) versus mastectomy, within a randomized anaesthesiology trial framework.

Q: How were overall survival and breast cancer-specific survival analyzed?

Overall survival (OS) and breast cancer-specific survival (BCSS) were estimated using multivariable Cox regression analyses and three different propensity score models.

Q: What were the main findings for BCSS and OS?

BCSS showed no significant differences between treatment groups after adjustment, while OS was significantly less favorable for mastectomy in unadjusted and adjusted analyses and most propensity score analyses.

Sep 22, 2026

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Background: Large randomized studies report comparable survival after breast-conserving surgery plus adjuvant radiotherapy (BCS+RT) and mastectomy, while newer observational data suggest BCS+RT may be superior, raising comparability concerns. Methods: Using patients from the randomized CAN-study, overall survival (OS) and breast cancer-specific survival (BCSS) were assessed with multivariable Cox regression and three propensity score models. Results: OS was worse with mastectomy across analyses; BCSS was equal after adjustment. Conclusion: No significant BCSS difference was observed; OS differences likely reflect selection bias.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Methods and Analyses

Results

Conclusion

BJS, 2026, znag036 [https://doi.org/10.1093/bjs/znag036](https://doi.org/10.1093/bjs/znag036) Original Article Survival after breast-conserving surgery and radiotherapy versus mastectomy: propensity score analyses within a randomized anaesthesiology trial Charlotta Wadsten1,2,* , Anders Berglund3, Emma Söderberg1,2 , Greger Nilsson4,5,6, Leif Bergkvist7, Mats Enlund7,8,9 and Fredrik Wärnberg10,11 1Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden 2Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden 3Department of Statistics, Epistat AB, Uppsala, Sweden 4Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden 5Department of Oncology, Gävle Hospital, Gävle, Sweden 6Department of Oncology, Visby Hospital, Visby, Sweden 7Centre for Clinical Research, Uppsala University and Region Vastmanland, Vastmanland Hospital, Västerås, Sweden 8Department of Surgical Sciences, Division of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden 9ESAIC Onco Anaestehesiology Group, EuroPeriscope 10Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden 11Institution of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden *Correspondence to: Charlotta Wadsten, Department of Surgery, Sundsvall Hospital, Sundsvall, 851 86, Sweden (e-mail: [charlotta.wadsten@umu.se](charlotta.wadsten@umu.se)) Preliminary results were presented at the 44th Congress of the European Society of Surgical Oncology (ESSO), Gothenburg, Sweden, October 2025. Abstract Background: Large randomized studies show equivalent survival after breast-conserving surgery (BCS) + adjuvant radiotherapy (RT) and mastectomy. In contrast, more recent observational studies suggest BCS + RT to be superior, but it is questionable whether patients in these treatment arms are comparable. Here, overall survival (OS) and breast cancer-specific survival (BCSS) after BCS + RT and mastectomy are compared within a randomized trial comparing intravenous and inhalation anaesthesia during breast cancer surgery. Methods: The patient cohort was recruited from the randomized CAN-study. Patients with tumours >30 mm, patients with tumours <10 mm, and patients who underwent BCS without RT were excluded. OSand BCSS were estimated using multivariable Cox regression analyses and three different propensity score models. Results: The final study cohort included 830 women, of whom 601 underwent BCS + RT (median age 64 years) and 229 underwent mastectomy (median age 68 years) . Women who underwent mastectomy had more co-morbidities and more unfavourable tumour characteristics. Mastectomy was associated with significantly less favourable OS in unadjusted, adjusted, and two of the three propensity score analyses. BCSS was inferior in the mastectomy group in the unadjusted analysis, with an HR of 2.27 (95% c.i. 1.20 to 4.30) . In the adjusted and three propensity score analyses, BCSS was equal in the treatment groups, with an adjusted HR of 1.02 (95% c.i. 0.43 to 2.42) . Conclusion: In this study, which was designed to approximate a randomized trial as closely as possible, no significant difference in BCSS was observed between BCS + RT and mastectomy. Differences in OS likely reflect occult selection bias of patients with higher co-morbidity burden to mastectomy. Introduction Since the early 1990s, breast conservation has been recommended as the primary surgical choice for early breast cancer. This is based on results from several randomized studies, comparing breast-conserving surgery (BCS) with adjuvant radiotherapy (RT) and mastectomy1,2. Overall survival (OS) and breast cancer-specific survival (BCSS) were shown to be similar after 20 years, but with a higher risk of local recurrence after BCS3,4. Presenting BCS + RT as the primary surgical choice for women when BCS is possible is not controversial, but, still, mastectomy is often opted for

FAQs

What treatments are compared in the study?

The study compares breast-conserving surgery plus adjuvant radiotherapy (BCS+RT) versus mastectomy, within a randomized anaesthesiology trial framework.

How were overall survival and breast cancer-specific survival analyzed?

Overall survival (OS) and breast cancer-specific survival (BCSS) were estimated using multivariable Cox regression analyses and three different propensity score models.

What were the main findings for BCSS and OS?

BCSS showed no significant differences between treatment groups after adjustment, while OS was significantly less favorable for mastectomy in unadjusted and adjusted analyses and most propensity score analyses.

Sep 22, 2026

Upload by วิน