Efficacy Of Breast-conserving Surgery For Mammary Paget's Disease Systematic Review And Meta-analysis

Objective. Exploration into the feasibility of replacing mastectomy with breast-conserving surgery(BCS) by means of local breast cancer recurrence(LBCR) and overall survival(OS) in mammary Paget's disease.Methods. We included Case Control Study(CCS) of breast-conserving therapy for Paget's disease comparing with mastectomy. The outcome was LBCR, OS. The participants were those women ?18 years of age undergoing surgery for the first time. We searched Ovid MEDLINE?EMBASE?Pub Med?Wiley Online Library?and CNKI(up to the date of February 19 th, 2016). Two reviewers independently identified the included researches, evaluated their methodological quality and extracted data. The Cochrane collaboration's Review Manager 5.3 and STATA 12.0 software were used for data analysis. Dichotomous data were showed by using the relative risk(RR) and 95% CI.Results. The search retrieved 1923 titles, of which 7 original CCSs were included in this systematic review. The overall risk of bias was low in all 7 titles. There were six CCSs focused on LBCR as the evaluation criteria. The sample size was 158 cased of BCS group, compared with 482 cases of mastectomy group. Five CCSs focused on OS. Sample size was 153 cases of BCS group, compared with 427 cases of mastectomy group. The outcome analysis showed:(1) Six researches(n=640) focused on LBCR showed BCS group got significantly more cancer recurrence than mastectomy group.(RR 2.36, 95% CI 1.31~4.28). We maintained this conclusion after sensitivity analysis.(2) Five researches(n=580) focused on OS showed BCS group had significantly higher OS than group of mastectomy(RR 1.17, 95% CI 1.04~1.32). After sensitivity analysis, we reached a conservative conclusion that BCS had significantly same OS compared with mastectomy.Conclusions. Based on the existing research, breast-conserving surgery had same survival rate but a higher rate of local recurrence compared with mastectomy in mammary Paget's disease. In conclusion, breast-conserving surgery for mammary Paget's disease might have the same or worse effect. Only when sufficient preoperative examination performed, BCS became an optional, and systemic treatment including chemotherapy, immunotherapy or biological response modifiers or hormone therapy should be used. Otherwise, mastectomy is still first option in treatment of mammary Paget's disease.