Quality of life in breast cancer patients after radical and breast-conserving surgery: regression analysis of prognostic factors
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16392Keywords:
cancer, quality of life, organ-preserving surgery, breastAbstract
The aim of the work: to assess quality of life (QoL) in breast cancer (BC) patients after radical mastectomy (RM) versus breast-conserving surgery (BCS) and to identify independent predictors of QoL impairment.
Materials and Methods. A cross-sectional study included 60 patients, mean age (49.6±12.1) years, treated at the Antitumor Center (Uzhhorod, Ukraine). The study was conducted in accordance with the Declaration of Helsinki of the World Medical Association (1964, as last amended in 2013). The study protocol was approved by the Local Ethics Committee of the Anti-Cancer Center (protocol No. 408 dated 17.11.2023). All patients signed an informed consent to participate in the study, including the processing of personal data in an anonymized form. QoL was assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. Statistical analysis was performed with JAMOVI (t-test, ANOVA, Spearman's correlation, multiple linear regression).
Results. Global health status was (55.6±19.3) points. BCS was associated with better body image (+25.0 points; p<0.001), higher emotional functioning (+12.8; p=0.008), and fewer arm symptoms (-17.8; p=0.004). After >3 years post-surgery, fatigue, pain, and financial difficulties decreased (p<0.05). Regression analysis revealed that surgery type was the strongest predictor of body image (β=0.62; p<0.001). High Ki-67 correlated with greater fatigue (ρ=0.34; p=0.008) and worse body image (B=-6.89; p=0.027). The obtained results support previous findings regarding the significant benefits of breast-conserving surgery in reducing psychological distress. The Ki-67 level is an important factor to consider when predicting quality of life.
Conclusions. Breast-conserving surgery provides significantly better QoL, particularly in body image and emotional functioning. Ki-67 is an independent predictor of fatigue and body image. These findings support BCS as the preferred approach when oncologically feasible.
References
1. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025; 75(1):10-45. PMID: 39817679. PMCID: PMC11745215. DOI: 10.3322/caac.21871. DOI: https://doi.org/10.3322/caac.21871
2. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021. DOI: 10.1002/ijc.33588. DOI: https://doi.org/10.1002/ijc.33588
3. Fedorenko Z, Mykhaylovych YU, Hulak L, ta in. Rak v Ukrayini, 2023–2024. Bull Nat Cancer Registry Ukraine [Cancer in Ukraine, 2023–2024. Bull Nat Cancer Registry Ukraine]. Kyyiv. 2025; 26. Available from: http://www.ncru.inf.ua/publications/. Ukrainian.
4. Kovalʹov OO, Kostyuk OH, Tkachuk TV. Viyna yak faktor ryzyku raku molochnoyi zalozy. Scientific progress: innovations, achievements and prospects [War as a risk factor for breast cancer. Scientific progress: innovations, achievements and prospects]. Munich. MDPC Publishing. 2023; 34-8. Available from: https://dspace.vnmu.edu.ua/123456789/9591. Ukrainian.
5. Waks AG, Winer EP. Breast Cancer Treatment: A Review. JAMA. 2019; 321(3):288-300. DOI: 10.1001/jama.2018.19323. DOI: https://doi.org/10.1001/jama.2018.19323
6. Łukasiewicz S, Czeczelewski M, Forma A, et al. Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review. Cancers (Basel). 2021; 13(17):4287. DOI: 10.3390/cancers13174287. DOI: https://doi.org/10.3390/cancers13174287
7. Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013; 20(11):3469-76. DOI: 10.1245/s10434-013-3011-9. DOI: https://doi.org/10.1245/s10434-013-3011-9
8. Cipora E, Konieczny M, Karwat ID, Roczniak W, Babuśka-Roczniak M. Surgical method of treatment and level of satisfaction with life among women diagnosed with breast cancer, according to time elapsed since performance of surgery. Ann Agric Environ Med. 2018; 25(3):453-59. DOI: 10.26444/aaem/91586. DOI: https://doi.org/10.26444/aaem/91586
9. Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015; 16(3):266-73. DOI: 10.1016/S1470-2045(14)71221-5. DOI: https://doi.org/10.1016/S1470-2045(14)71221-5
10. Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013; 14(11):1086-94. DOI: 10.1016/S1470-2045(13)70386-3. DOI: https://doi.org/10.1016/S1470-2045(13)70386-3
11. McGale P, Correa C, Cutter D, Duane F, Ewertz M, Gray R, Mannu G, Peto R, Whelan T, Darby S. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet. 2014 Jun. 21; 383(9935):2127-35. DOI: 10.1016/S0140-6736(14)60488-8. DOI: https://doi.org/10.1016/S0140-6736(14)60488-8
12. Andrés-Sánchez N, Fisher D, Krasinska L. Physiological functions and roles in cancer of the proliferation marker Ki-67. J Cell Sci. 2022; 135(11):jcs258932. DOI: 10.1242/jcs.258932. DOI: https://doi.org/10.1242/jcs.258932
13. Menon SS, Guruvayoorappan C, Sakthivel KM, Rasmi RR. Ki-67 protein as a tumour proliferation marker. Clin Chim Acta. 2019; 491:39-45. DOI: 10.1016/j.cca.2019.01.011. DOI: https://doi.org/10.1016/j.cca.2019.01.011
14. Davey MG, Hynes SO, Kerin MJ, Miller N, Lowery AJ. Ki-67 as a Prognostic Biomarker in Invasive Breast Cancer. Cancers (Basel). 2021; 13(17):4455. DOI: 10.3390/cancers13174455. DOI: https://doi.org/10.3390/cancers13174455
15. Tao M, Chen S, Zhang X, Zhou Q. Ki-67 labeling index is a predictive marker for a pathological complete response to neoadjuvant chemotherapy in breast cancer: A meta-analysis. Medicine (Baltimore). 2017; 96(51):e9384. DOI: 10.1097/MD. 0000000000009384. DOI: https://doi.org/10.1097/MD.0000000000009384
16. Ács B, Zámbó V, Vízkeleti L, et al. Ki-67 as a controversial predictive and prognostic marker in breast cancer patients treated with neoadjuvant chemotherapy. Diagn Pathol. 2017; 12(1):20. DOI: 10.1186/s13000-017-0608-5. DOI: https://doi.org/10.1186/s13000-017-0608-5
17. Obeagu EI, Obeagu GU. Predictive models and biomarkers for survival in stage III breast cancer: a review of clinical applications and future directions. Ann Med Surg (Lond). 2024; 86(10):5980-87. DOI: 10.1097/MS9.0000000000002517. DOI: https://doi.org/10.1097/MS9.0000000000002517
18. Regan MM, Pagani O, Francis PA, et al. Predictive value and clinical utility of centrally assessed ER, PgR, and Ki-67 to select adjuvant endocrine therapy for premenopausal women with hormone receptor-positive, HER2-negative early breast cancer: TEXT and SOFT trials. Breast Cancer Res Treat. 2015; 154(2):275-86. DOI: 10.1007/s10549-015-3612-z. DOI: https://doi.org/10.1007/s10549-015-3612-z
19. Sparano JA, Gray RJ, Makower DF, et al. Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. N Engl J Med. 2018; 379(2):111-21. DOI: 10.1056/NEJMoa1804710. DOI: https://doi.org/10.1056/NEJMoa1804710
20. Ko NY, Hong S, Winn RA, Calip GS. Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer. JAMA Oncol. 2020; 6(3):385-92. DOI: 10.1001/jamaoncol.2019.5672. DOI: https://doi.org/10.1001/jamaoncol.2019.5672
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