Introduction
Methods
Patients selection
Variables
Statistical analysis
Results
Baseline characteristics
Characteristics | Before PSM | After PSM | ||||
---|---|---|---|---|---|---|
Mastectomy N = 8597 | BCS N = 6416 | P value | Mastectomy N = 4865 | BCS N = 4865 | P value | |
Year of diagnosis | ||||||
2004–2007 | 2894 (33.7) | 2178 (33.9) | 0.008 | 1746 (35.9) | 1758 (36.1) | 0.826 |
2008–2011 | 2260 (26.3) | 1551 (24.2) | 1056 (21.7) | 1031 (21.2) | ||
2012–2015 | 3443 (40.0) | 2687 (41.9) | 2063 (42.4) | 2076 (42.7) | ||
Age at diagnosis, yrs | ||||||
18–40 | 794 (9.2) | 275 (4.3) | < 0.001 | 153 (3.1) | 159 (3.3) | 0.941 |
41–50 | 2178 (25.3) | 1234 (19.2) | 906 (18.6) | 913 (18.8) | ||
51–60 | 2812 (32.7) | 2304 (35.9) | 1733 (35.6) | 1748 (35.9) | ||
61–70 | 2813 (32.7) | 2603 (40.6) | 2073 (42.6) | 2045 (42.0) | ||
Race | ||||||
White | 6609 (76.9) | 5188 (80.9) | < 0.001 | 4260 (87.6) | 4223 (86.8) | 0.495 |
Black | 805 (9.4) | 626 (9.8) | 258 (5.3) | 293 (6.0) | ||
Other | 1151 (13.4) | 573 (8.9) | 344 (7.1) | 346 (7.1) | ||
Unknown | 32 (0.4) | 29 (0.5) | 3 (0.1) | 3 (0.1) | ||
Marital status | ||||||
Unmarried | 3000 (34.9) | 2159 (33.7) | 0.03 | 1536 (31.6) | 1529 (31.4) | 0.877 |
Married | 5253 (61.1) | 4038 (62.9) | 3259 (67.0) | 3260 (67.0) | ||
Unknown | 344 (4.0) | 219 (3.4) | 70 (1.4) | 76 (1.6) | ||
Histological type | ||||||
IDC | 6305 (73.3) | 4827 (75.2) | < 0.001 | 3915 (80.5) | 3898 (80.1) | 0.903 |
ILC | 785 (9.1) | 434 (6.8) | 250 (5.1) | 252 (5.2) | ||
Others | 1507 (17.5) | 1155 (18.0) | 700 (14.4) | 715 (14.7) | ||
Grade | ||||||
G1 | 1407 (16.4) | 1626 (25.3) | < 0.001 | 1291 (26.5) | 1292 (26.6) | 0.907 |
G2 | 3861 (44.9) | 2949 (46.0) | 2367 (48.7) | 2353 (48.4) | ||
G3/4 | 2932 (34.1) | 1555 (24.2) | 1094 (22.5) | 1096 (22.5) | ||
Unknown | 397 (4.6) | 286 (4.5) | 113 (2.3) | 124 (2.5) | ||
Tumor stage, AJCC 6th | ||||||
T1 | 4439 (51.6) | 4927 (76.8) | < 0.001 | 3779 (77.7) | 3807 (78.3) | 0.509 |
T2 | 4158 (48.4) | 1489 (23.2) | 1086 (22.3) | 1058 (21.7) | ||
Node stage, AJCC 6th | ||||||
N0 | 4667 (54.3) | 4773 (74.4) | < 0.001 | 3707 (76.2) | 3720 (76.5) | 0.759 |
N1 | 2801 (32.6) | 1411 (22.0) | 1057 (21.7) | 1031 (21.2) | ||
N2 | 777 (9.0) | 172 (2.7) | 80 (1.6) | 89 (1.8) | ||
N3 | 352 (4.1) | 60 (0.9) | 21 (0.4) | 25 (0.5) | ||
ER status | ||||||
Negative | 1368 (15.9) | 767 (12.0) | < 0.001 | 460 (9.5) | 478 (9.8) | 0.531 |
Positive | 6943 (80.8) | 5528 (86.2) | 4356 (89.5) | 4347 (89.4) | ||
Unknown | 286 (3.3) | 121 (1.9) | 49 (1.0) | 40 (0.8) | ||
PR status | ||||||
Negative | 2319 (27.0) | 1417 (22.1) | < 0.001 | 825 (17.0) | 858 (17.6) | 0.56 |
Positive | 5915 (68.8) | 4817 (75.1) | 3979 (81.8) | 3953 (81.3) | ||
Unknown | 363 (4.2) | 182 (2.8) | 61 (1.3) | 54 (1.1) | ||
HER2 status | ||||||
Negative | 3189 (37.1) | 2651 (41.3) | < 0.001 | 2082 (42.8) | 2080 (42.8) | 0.923 |
Positive | 770 (9.0) | 384 (6.0) | 207 (4.3) | 215 (4.4) | ||
Unknown | 4638 (53.9) | 3381 (52.7) | 2576 (52.9) | 2570 (52.8) | ||
Chemotherapy | ||||||
No/Unknown | 3826 (44.5) | 3782 (58.9) | < 0.001 | 3036 (62.4) | 3028 (62.2) | 0.884 |
Yes | 4771 (55.5) | 2634 (41.1) | 1829 (37.6) | 1837 (37.8) |
Features | Before PSM | After PSM | ||||
---|---|---|---|---|---|---|
non-CLBC N = 118,211 | CLC N = 6416 | P value | non-CLBC N = 6416 | CLBC N = 6416 | P value | |
Year of diagnosis | ||||||
2004–2007 | 36,599 (31.0) | 2178 (33.9) | < 0.001 | 2197 (34.2) | 2178 (33.9) | 0.899 |
2008–2011 | 28,133 (23.8) | 1551 (24.2) | 1531 (23.9) | 1551 (24.2) | ||
2012–2015 | 53,479 (45.2) | 2687 (41.9) | 2688 (41.9) | 2687 (41.9) | ||
Age at diagnosis, yrs | ||||||
18–40 | 6347 (5.4) | 275 (4.3) | < 0.001 | 271 (4.2) | 275 (4.3) | 0.963 |
41–50 | 27,260 (23.1) | 1234 (19.2) | 1222 (19.0) | 1234 (19.2) | ||
51–60 | 41,748 (35.3) | 2304 (35.9) | 2291 (35.7) | 2304 (35.9) | ||
61–70 | 42,856 (36.3) | 2603 (40.6) | 2632 (41.0) | 2603 (40.6) | ||
Race | ||||||
White | 95,056 (80.4) | 5188 (80.9) | 0.316 | 5257 (81.9) | 5188 (80.9) | 0.159 |
Black | 12,333 (10.4) | 626 (9.8) | 607 (9.5) | 626 (9.8) | ||
Other | 10,356 (8.8) | 573 (8.9) | 535 (8.3) | 573 (8.9) | ||
Unknown | 466 (0.4) | 29 (0.5) | 17 (0.3) | 29 (0.5) | ||
Marital status | ||||||
Unmarried | 39,066 (33.0) | 2159 (33.7) | 0.607 | 2162 (33.7) | 2159 (33.7) | 0.839 |
Married | 75,063 (63.5) | 4038 (62.9) | 4047 (63.1) | 4038 (62.9) | ||
Unknown | 4082 (3.5) | 219 (3.4) | 207 (3.2) | 219 (3.4) | ||
Histological type | ||||||
IDC | 93,211 (78.9) | 4827 (75.2) | < 0.001 | 4866 (75.8) | 4827 (75.2) | 0.427 |
ILC | 7496 (6.3) | 434 (6.8) | 449 (7.0) | 434 (6.8) | ||
Others | 17,504 (14.8) | 1155 (18.0) | 1101 (17.2) | 1155 (18.0) | ||
Grade | ||||||
G1 | 31,186 (26.4) | 1626 (25.3) | < 0.001 | 1586 (24.7) | 1626 (25.3) | 0.576 |
G2 | 48,523 (41.0) | 2949 (46.0) | 2948 (45.9) | 2949 (46.0) | ||
G3/4 | 34,729 (29.4) | 1555 (24.2) | 1612 (25.1) | 1555 (24.2) | ||
Unknown | 3773 (3.2) | 286 (4.5) | 270 (4.2) | 286 (4.5) | ||
Tumor stage, AJCC 6th | ||||||
T1 | 89,048 (75.3) | 4927 (76.8) | 0.008 | 4892 (76.2) | 4927 (76.8) | 0.479 |
T2 | 29,163 (24.7) | 1489 (23.2) | 1524 (23.8) | 1489 (23.2) | ||
Node stage, AJCC 6th | ||||||
N0 | 92,813 (78.5) | 4773 (74.4) | < 0.001 | 4776 (74.4) | 4773 (74.4) | 0.218 |
N1 | 20,972 (17.7) | 1411 (22.0) | 1379 (21.5) | 1411 (22.0) | ||
N2 | 3275 (2.8) | 172 (2.7) | 177 (2.8) | 172 (2.7) | ||
N3 | 1151 (1.0) | 60 (0.9) | 84 (1.3) | 60 (0.9) | ||
ER status | ||||||
Negative | 19,487 (16.5) | 767 (12.0) | < 0.001 | 753 (11.7) | 767 (12.0) | 0.665 |
Positive | 97,003 (82.1) | 5528 (86.2) | 5554 (86.6) | 5528 (86.2) | ||
Unknown | 1721 (1.5) | 121 (1.9) | 109 (1.7) | 121 (1.9) | ||
PR status | ||||||
Negative | 30,499 (25.8) | 1417 (22.1) | < 0.001 | 1427 (22.2) | 1417 (22.1) | 0.448 |
Positive | 85,134 (72.0) | 4817 (75.1) | 4830 (75.3) | 4817 (75.1) | ||
Unknown | 2578 (2.2) | 182 (2.8) | 159 (2.5) | 182 (2.8) | ||
HER2 status | ||||||
Negative | 53,185 (45.0) | 2651 (41.3) | < 0.001 | 2661 (41.5) | 2651 (41.3) | 0.927 |
Positive | 7313 (6.2) | 384 (6.0) | 374 (5.8) | 384 (6.0) | ||
Unknown | 57,713 (48.8) | 3381 (52.7) | 3381 (52.7) | 3381 (52.7) | ||
Chemotherapy | ||||||
No/Unknown | 67,251 (56.9) | 3782 (58.9) | 0.001 | 3739 (58.3) | 3782 (58.9) | 0.452 |
Yes | 50,960 (43.1) | 2634 (41.1) | 2677 (41.7) | 2634 (41.1) |
Survival analyses before PSM
Survival analyses after PSM
Characteristic | No. at risk | BCSS | OS | ||
---|---|---|---|---|---|
HR (95%CI) | P value | HR (95%CI) | P value | ||
Surgery | |||||
Mastectomy | 4865 | Reference | Reference | ||
BCS | 4865 | 0.65(0.47–0.90) | 0.009 | 0.82(0.65–1.04) | 0.109 |
Year of diagnosis | |||||
2004–2007 | 3504 | Reference | Reference | ||
2008–2011 | 2087 | 0.51(0.38–0.68) | < 0.001 | 7.46(0.63–0.88) | 0.0005 |
2012–2015 | 4139 | 0.36(0.21–0.62) | 0.0002 | 0.42(0.31–0.59) | < 0.001 |
Age at diagnosis, yrs | |||||
18–40 | 312 | Reference | Reference | ||
41–50 | 1819 | 0.63(0.41–0.95) | 0.026 | 0.87(0.60–1.26) | 0.468 |
51–60 | 3481 | 0.63(0.43–0.94) | 0.022 | 1.07(0.75–1.51) | 0.717 |
61–70 | 4118 | 0.98(0.67–1.44) | 0.937 | 2.22(1.57–3.12) | < 0.001 |
Race | |||||
White | 8483 | Reference | Reference | ||
Black | 551 | 1.68(1.21–2.33) | 0.002 | 1.82(1.48–2.23) | < 0.001 |
Other | 690 | 0.42(0.24–0.73) | 0.002 | 7.82(0.59–1.03) | 0.085 |
Unknown | 6 | NA | NA | NA | NA |
Marital status | |||||
Unmarried | 3065 | Reference | Reference | ||
Married | 6519 | 1.28(1.04–1.58) | 0.019 | 0.89(0.79–1.01) | 0.079 |
Unknown | 146 | 2.73(1.38–5.40) | 0.004 | 1.69(1.06–2.68) | 0.026 |
Histological type | |||||
IDC | 7813 | Reference | Reference | ||
ILC | 502 | 0.54(0.30–0.97) | 0.038 | 1.03(0.77–1.37) | 0.856 |
Others | 1415 | 0.46(0.31–0.68) | 0.0001 | 1.01(0.85–1.20) | 0.916 |
Grade | |||||
G1 | 2583 | Reference | Reference | ||
G2 | 4720 | 3.80(2.51–5.74) | < 0.001 | 1.16(0.99–1.36) | 0.065 |
G3/4 | 2190 | 6.82(4.41–10.55) | < 0.001 | 1.89(1.56–2.30) | < 0.001 |
Unknown | 237 | 2.70(1.16–6.30) | 0.022 | 0.98(0.65–1.47) | 0.907 |
Tumor stage, AJCC 6th | |||||
T1 | 7586 | Reference | Reference | ||
T2 | 2144 | 2.12(1.72–2.61) | < 0.001 | 1.65(1.43–1.90) | < 0.001 |
Node stage, AJCC 6th | |||||
N0 | 7427 | Reference | Reference | ||
N1 | 2088 | 1.90(1.51–2.40) | < 0.001 | 1.97(1.54–2.10) | < 0.001 |
N2 | 169 | 4.50(3.05–6.66) | < 0.001 | 3.04(2.23–4.15) | < 0.001 |
N3 | 46 | 4.89(2.77–8.62) | < 0.001 | 3.21(1.95–5.28) | < 0.001 |
ER status | |||||
Negative | 938 | Reference | Reference | ||
Positive | 8703 | 1.00(0.71–1.43) | 0.975 | 0.80(0.62–1.02) | 0.070 |
Unknown | 89 | 1.95(0.37–10.34) | 0.434 | 0.88(0.33–2.34) | 0.791 |
PR status | |||||
Negative | 1683 | Reference | Reference | ||
Positive | 7932 | 0.84(0.63–1.12) | 0.242 | 0.92(0.75–1.12) | 0.408 |
Unknown | 115 | 0.42(0.08–2.17) | 0.297 | 0.84(0.35–2.02) | 0.701 |
HER2 status | |||||
Negative | 4162 | Reference | Reference | ||
Positive | 422 | 0.74(0.39–1.40) | 0.360 | 0.94(0.61–1.44) | 0.769 |
Unknown | 5146 | 0.55(0.34–0.90) | 0.016 | 0.68(0.52–0.90) | 0.007 |
Radiotherapy | |||||
No/Unknown | 4275 | Reference | Reference | ||
Yes | 5455 | 0.80(0.57–1.10) | 0.169 | 0.96(0.75–1.23) | 0.770 |
Chemotherapy | |||||
No/Unknown | 6064 | Reference | Reference | ||
Yes | 3666 | 0.71(0.56–0.91) | 0.006 | 0.64(0.54–0.75) | < 0.001 |
Characteristics | BCSS | OS | ||
---|---|---|---|---|
HR (95%CI) | P value | HR (95%CI) | P value | |
Year of diagnosis | ||||
2004–2007 | Reference | Reference | ||
2008–2011 | 0.98(0.78–1.25) | 0.896 | 1.19(1.03–1.38) | 0.019 |
2011–2015 | 0.93(0.62–1.41) | 0.740 | 1.38(1.06–1.80) | 0.017 |
Age at diagnosis, yrs | ||||
18–40 | Reference | Reference | ||
41–50 | 0.82(0.59–1.16) | 0.267 | 0.88(0.65–1.18) | 0.388 |
51–60 | 0.72(0.52–1.00) | 0.050 | 1.05(0.79–1.38) | 0.745 |
61–70 | 0.80(0.58–1.12) | 0.198 | 1.98(1.51–2.61) | < 0.001 |
Race | ||||
White | Reference | Reference | ||
Black | 1.56(1.24–1.97) | < 0.001 | 1.52(1.30–1.78) | < 0.001 |
Other | 0.91(0.65–1.29) | 0.607 | 0.89(0.72–1.11) | 0.306 |
Unknown | 0.84(0.12–5.99) | 0.861 | 0.30(0.04–2.10) | 0.223 |
Marital status | ||||
Unmarried | Reference | Reference | ||
Married | 0.75(0.63–0.90) | 0.002 | 0.77(0.69–0.86) | < 0.001 |
Unknown | 0.73(0.42–1.28) | 0.268 | 0.68(0.48–0.97) | 0.035 |
Histological type | ||||
IDC | Reference | Reference | ||
ILC | 1.06(0.73–1.55) | 0.748 | 0.85(0.67–1.08) | 0.189 |
Others | 0.86(0.66–1.11) | 0.245 | 0.80(0.69–0.93) | 0.004 |
Grade | ||||
G1 | Reference | Reference | ||
G2 | 2.16(1.5–3.09) | < 0.001 | 0.97(0.84–1.12) | 0.672 |
G3/4 | 3.65(2.51–5.3) | < 0.001 | 1.35(1.14–1.60) | < 0.001 |
Unknown | 2.86(1.66–4.92) | < 0.001 | 1.04(0.77–1.40) | 0.785 |
Tumor stage, AJCC 6th | ||||
T1 | Reference | Reference | ||
T2 | 2.20(1.82–2.66) | < 0.001 | 1.68(1.48–1.90) | < 0.001 |
Node stage, AJCC 6th | ||||
N0 | Reference | Reference | ||
N1 | 2.00(1.62–2.47) | < 0.001 | 1.56(1.36–1.79) | < 0.001 |
N2 | 3.04(2.19–4.23) | < 0.001 | 2.32(1.81–2.98) | < 0.001 |
N3 | 5.96(4.14–8.58) | < 0.001 | 3.85(2.83–5.23) | < 0.001 |
ER status | ||||
Negative | Reference | Reference | ||
Positive | 1.02(0.76–1.37) | 0.882 | 0/76(0.62–0.94) | 0.009 |
Unknown | 1.06(0.36–3.17) | 0.911 | 0.63(0.34–1.17) | 0.145 |
PR status | ||||
Negative | Reference | Reference | ||
Positive | 0.66(0.52–0.85) | 0.001 | 1.00(0.85–1.19) | 0.968 |
Unknown | 0.74(0.28–1.93) | 0.538 | 1.18(0.72–1.93) | 0.513 |
HER2 status | ||||
Negative | Reference | Reference | ||
Positive | 0.72(0.46–1.12) | 0.146 | 0.89(0.64–1.23) | 0.470 |
Unknown | 0.86(0.60–1.23) | 0.412 | 1.12(0.89–1.41) | 0.349 |
Chemotherapy | ||||
No/Unknown | Reference | Reference | ||
Yes | 1.20(0.95–1.52) | 0.126 | 0.76(0.67–0.88) | < 0.001 |
Tumor location | ||||
Non-central | Reference | Reference | ||
Central | 1.05(0.88–1.24) | 0.615 | 1.08(0.97–1.20) | 0.168 |