Abstract
Background
Controversy exists regarding the appropriateness of immediate breast reconstruction
(IBR) in patients with metastatic breast cancer (MBC).
Patients and Methods
By using the Surveillance, Epidemiology, and End Results (SEER) database, data of
patients with de novo MBC undergoing mastectomy with or without IBR were assessed.
The trend of IBR in de novo MBC was explored. Comparisons of the distribution of clinicopathologic
characteristics were evaluated by chi-square and Fisher exact tests. The predictors
of IBR in de novo MBC were evaluated by multivariate logistic regression. The survival
outcomes were compared by Cox hazards models adjusting for known clinicopathologic
variables in both the entire population and in the matched cohorts.
Results
Between 1998 and 2015, 5.2% of patients with de novo MBC undergoing mastectomy received
IBR. The rate of IBR increased significantly, from 6.3% in 1998 to 16.8% in 2015.
Patients undergoing IBR were younger and had smaller tumor size, fewer positive lymph
nodes, lower proportion of hormone receptor–negative disease and lung metastasis,
and better economic status. They were also more likely to receive radiotherapy and
chemotherapy. Although IBR was an independent favorable prognostic factor for breast
cancer–specific survival and overall survival in the whole population, there were
no statistically significant differences between IBR and mastectomy for breast cancer–specific
survival (P = .892) and overall survival (P = .708) in the well-matched analysis.
Conclusion
IBR in selected de novo MBC could be an acceptable practice when balancing quality
of life, underlying health care burden, and oncologic risks.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Breast CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2018.CA Cancer J Clin. 2018; 68: 7-30
- Initial surgery and survival in stage IV breast cancer in the United States, 1988-2011.JAMA Surg. 2016; 151: 424-431
- Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature.Breast Cancer Res Treat. 2015; 153: 617-624
- Survival of de novo stage IV breast cancer patients over three decades.J Cancer Res Clin Oncol. 2017; 143: 509-519
- Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis.J Clin Oncol. 2006; 24: 2743-2749
- Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter?.Cancer. 2010; 116: 1226-1233
- Association of surgery with improved survival in stage IV breast cancer patients.Ann Surg. 2008; 247: 732-738
- Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis?.Int J Radiat Oncol Biol Phys. 2012; 84: 39-45
- Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes?.Breast. 2011; 20: 548-554
- Improved survival after primary tumor surgery in metastatic breast cancer: a propensity-adjusted, population-based SEER trend analysis.Ann Surg. 2016; 263: 1188-1198
- Surgery of primary tumors in stage IV breast cancer: an updated meta-analysis of published studies with meta-regression.Med Oncol. 2012; 29: 3282-3290
- Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial.Lancet Oncol. 2015; 16: 1380-1388
- Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: protocol MF07-01.Ann Surg Oncol. 2018; 25: 3141-3149
- The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer.Cancer. 2007; 110: 973-979
- Improved survival in metastatic breast cancer, 1985-2016.Breast. 2017; 31: 46-50
- Survival with metastatic breast cancer based on initial presentation, de novo versus relapsed.Breast Cancer Res Treat. 2017; 161: 549-556
- Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer?.Br J Cancer. 2015; 112: 1445-1451
Lane WO, Thomas SM, Blitzblau RC, et al. Surgical resection of the primary tumor in women with de novo stage IV breast cancer: contemporary practice patterns and survival analysis [e-pub ahead of print]. Ann Surg. https://doi.org/10.1097/SLA.0000000000002621. Accessed December 7, 2017.
Fitzal F, Bjelic-Radisic V, Knauer M, et al. Impact of breast surgery in primary metastasized breast cancer: outcomes of the prospective randomized phase III ABCSG-28 POSYTIVE trial [e-pub ahead of print]. Ann Surg. https://doi.org/10.1097/SLA.0000000000002771. Accessed April 24, 2018.
- A role for curative surgery in the treatment of selected patients with metastatic breast cancer.Oncologist. 2003; 8: 241-251
- Readdressing the role of surgery of the primary tumor in de novo stage IV breast cancer.Cancer Treat Res. 2018; 173: 73-88
- Surgical management of de novo stage IV breast cancer.J Natl Compr Canc Netw. 2015; 13: 487-493
- 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4).Ann Oncol. 2018; 29: 1634-1657
- Informational needs and the quality of life of patients in their first year after metastatic breast cancer diagnosis.J Commun Support Oncol. 2014; 12: 347-354
- Quality of life after mastectomy with or without immediate breast reconstruction.Br J Surg. 2017; 104: 1197-1206
- Informational needs of patients with metastatic breast cancer: what questions do they ask, and are physicians answering them?.J Cancer Educ. 2014; 29: 175-180
- Reconstruction in the metastatic breast cancer patient: results from the National Cancer Data Base.Ann Surg Oncol. 2018; 25: 3125-3133
- Mastectomy and reconstruction in stage IV breast cancer: a survey of UK breast and plastic surgeons.Breast. 2011; 20: 373-379
- Surgical approach to pulmonary metastases from breast cancer.Breast J. 2012; 18: 52-57
- TRAM flap breast reconstruction for patients with advanced breast disease.Ann Plastic Surg. 2003; 50: 567-571
- Higher rate of breast surgery complications in patients with metastatic breast cancer: an analysis of the NSQIP database.Ann Surg Oncol. 2014; 21: 3167-3172
- Immediate free flap reconstruction for advanced-stage breast cancer: is it safe?.Plastic Reconstr Surg. 2011; 128: 32-41
- Challenging a traditional paradigm: 12-year experience with autologous free flap breast reconstruction for inflammatory breast cancer.Plastic Reconstr Surg. 2015; 135: 262e-269e
Article Info
Publication History
Published online: November 05, 2018
Accepted:
October 29,
2018
Received in revised form:
October 29,
2018
Received:
September 20,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
