Long-term outcomes of XXXX of the breast: a systematic review, meta-analysis and meta-regression analysis.

@entity1 @entity3821 @entity440 @entity0 @entity16235 @entity3
BACKGROUND: To summarize data on long-term ipsilateral local recurrence (LR) and @entity0 death rate (BCDR) for @entity1 with @entity3821 ( @entity3821 ) who received different treatments. METHODS: Systematic review and study-level meta-analysis of prospective (n   =   5) and retrospective (n   =   21) studies of @entity1 with pure @entity3821 and with median or mean follow-up time of >= 10  years. Meta-regression was performed to assess and adjust for effects of potential confounders - the average age of @entity1 , period of initial treatment, and of bias - follow-up duration on recurrence- and death-rates in each treatment group. LR and BCDR rates by local treatment used were reported. Outside of randomized trials, remaining studies were likely to have tailored @entity1 treatment according to the clinical situation. RESULTS: Nine thousand four hundred and four @entity3821 cases in 9391 @entity1 with 10-year follow-up were included. The adjusted meta-regression LR rate for mastectomy was 2.6  % (95 % CI, 0.8-4.5); breast-conserving surgery with radiotherapy (RT), 13.6  % (95 % CI, 9.8-17.4); breast-conserving surgery without RT, 25.5  % (95 % CI, 18.1-32.9); and biopsy-only (residual predominately low-grade @entity3821 following inadequate excision), 27.8  % (95 % CI, 8.4-47.1). RT   +   @entity440 ( @entity16235 ) in conservation surgery (CS) @entity1 resulted in lower LR compared to one or no adjuvant treatments: LR rate for CS   +   RT   +   @entity16235 , 9.7  %; CS   +   RT(no @entity16235 ), 14.1  %; CS   +   @entity16235 (no RT), 24.7  %; CS(alone), 25.1  % (linear trend for treatment P   <   0.0001). Compared to CS   +   RT   +   @entity16235 , a significantly higher invasive LR was observed for CS(alone), odds ratio (OR) 2.61 (P   <   0.0001); CS   +   @entity16235 (no RT), OR 2.52 (P   =   0.001); CS   +   RT(no @entity16235 ), OR 1.59 (P   =   0.022). BCDR was similar for mastectomy, breast-conserving surgery with or without RT (1.3-2.0  %) and non-significantly higher for biopsy-only (2.7  %). Additionally, the 15-year follow-up was reported where all like-studies had   >=    15-year data sets; the biopsy-only @entity1 had a meta-analysed total LR rate of 40.2  % and the invasive LR rate was 28.1  %. The biopsy-only @entity1 had a   >=    15-year BCDR (that included @entity1 with @entity3 ) of 17.9  %; the   >=    15-year BCDR was 55.2  % for those with invasive LR. CONCLUSIONS: More local intervention was associated with greater local control for @entity1 with @entity3821 at long-term follow-up. For @entity1 undergoing breast-conservation, invasive LR was significantly lower when two rather than one adjuvant treatment modalities were given.
