Surgery remains the foundation of curative therapy for non-metastatic breast cancer, but many patients do not undergo surgery. Evidence is limited regarding this population. We sought to assess factors associated with lack of surgery and overall survival (OS) in patients not receiving breast cancer surgery. Retrospective cohort study of patients in the US National Cancer Database treated in 2004–2016. The dataset comprised 2,696,734 patients; excluding patients with unknown surgical status or stage IV, cT0, cTx, or pIS, metastatic or recurrent disease resulted in 1,192,294 patients for analysis. Chi-square and Wilcoxon rank-sum tests were used to assess differences between groups. OS was analyzed using the Kaplan–Meier method with a Cox proportional hazards model performed to assess associated factors. In total 50,626 (4.3%) did not undergo surgery. Black race, age >50 years, lower income, uninsured or public insurance, and lower education were more prevalent in the non-surgical cohort; this group was also more likely to have more comorbidities, higher disease stage, and more aggressive disease biology. Only 3,689 non-surgical patients (7.3%) received radiation therapy (RT). Median OS time for the non-surgical patients was 58 months (3-year and 5-year OS rates 63% and 49%). Median OS times were longer for patients who received chemotherapy (80 vs 50 (no-chemo) months) and RT (85 vs 56 (no-RT) months). On multivariate analysis, age, race, income, insurance status, comorbidity score, disease stage, tumor subtype, treatment facility type and location, and receipt of RT were associated with OS. On subgroup analysis, receipt of chemotherapy improved OS for patients with triple negative (HR 0.66, 95% CI 0.59–0.75, P < 0.001) and HER2⁺ (HR 0.74, 95% CI 0.65–0.84, P < 0.001) subgroups while RT improved OS for ER⁺ (HR 0.72, 95% CI 0.64–0.82, P < 0.001) and favorable-disease (ER+, early-stage, age >60) (HR 0.61, 95% CI 0.45–0.83, P = 0.002) subgroups. Approximately 4% of women with breast cancer do not undergo surgery, particularly those with more aggressive disease and lower socioeconomic status. Despite its benefits, RT was underutilized. This study provides a benchmark of survival outcomes for patients who do not undergo surgery and highlights a potential role for use of RT.

手术仍然是非转移性乳腺癌治愈性治疗的基础，但许多患者并未接受手术。关于这一人群的证据有限。我们试图评估与未接受乳腺癌手术的患者缺乏手术和总生存 (OS) 相关的因素。美国国家癌症数据库中 2004-2016 年接受治疗的患者的回顾性队列研究。该数据集包括 2,696,734 名患者；排除手术状态未知或 IV 期、cT0、cTx 或 pIS 的患者，转移或复发疾病导致 1,192,294 名患者进行分析。卡方检验和 Wilcoxon 秩和检验用于评估组间差异。使用 Kaplan-Meier 方法分析 OS，并使用 Cox 比例风险模型来评估相关因素。总共 50,626 (4. 3%) 未接受手术。黑人种族、年龄 > 50 岁、收入较低、未投保或公共保险以及受教育程度较低在非手术队列中更为普遍；这个群体也更有可能有更多的合并症、更高的疾病阶段和更具侵略性的疾病生物学。只有 3,689 名非手术患者 (7.3%) 接受了放射治疗 (RT)。非手术患者的中位 OS 时间为 58 个月（3 年和 5 年 OS 率分别为 63% 和 49%）。接受化疗（80 与 50（无化疗）月）和放疗（85 与 56（无放疗）月）的患者的中位 OS 时间更长。在多变量分析中，年龄、种族、收入、保险状况、合并症评分、疾病分期、肿瘤亚型、治疗设施类型和位置以及接受放疗与 OS 相关。在亚组分析中，P  < 0.001) 和 HER2 ⁺ (HR 0.74, 95% CI 0.65–0.84, P  < 0.001) 亚组，而 RT 改善了 ER ⁺ (HR 0.72, 95% CI 0.64–0.82, P  < 0.001) 和有利疾病 ( P < 0.001) 的OS ER+、早期、年龄 >60）（HR 0.61，95% CI 0.45–0.83，P  = 0.002）亚组。大约 4% 的乳腺癌女性不接受手术，尤其是那些疾病更具侵袭性和社会经济地位较低的女性。尽管有好处，但 RT 并未得到充分利用。这项研究为未接受手术的患者提供了生存结果的基准，并强调了使用放疗的潜在作用。