Abstract
Background
There is no clear evidence of a survival benefit of resection of the primary tumor,
or distant site resection (metastasectomy) in patients with stage IV breast cancer.
Patients and Methods
This retrospective analysis of stage IV breast cancer using the National Cancer Database.
To evaluate variables associated with surgery at the primary site, we used univariate
analyses followed by multivariate logistic regression. Consequently, we evaluated
the impact of lumpectomy, mastectomy or metastasectomy on survival by conducting multivariate
Cox regression survival analyses on the following groups: all stage IV patients; a
subset of those with only one metastatic site; and another subset with metastasis
to multiple distant sites.
Results
A total of 54,871 stage IV breast cancer patients were included in this analysis.
Variables associated with the use of surgery at the primary were: age, race, Charlson/Deyo
score, insurance and facility type, involved breast quadrant, receptor status, N stage,
extent of metastasis, and year of diagnosis. Survival analysis showed that both lumpectomy
(median overall survival [OS], 45 months) and mastectomy (median OS, 44 months) were
associated with better OS compared to no surgery (median OS, 22 months). The statistical
effect was larger in the subgroup with metastasis to one site, but still significant
in the subgroup with multiple metastatic sites. Distant site resection also yielded
a survival benefit.
Conclusion
In patients with metastasis to only one site, metastasectomy was associated with better
OS when that site was the liver, lung, or brain.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-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
- Surgical resection of the primary tumor in women with de novo stage iv breast cancer: contemporary practice patterns and survival analysis.Ann Surg. 2019; 269: 537-544
- Cancer statistics, 2014.CA Cancer J Clin. 2014; 64: 9-29
- Palliative care: optimizing quality of life.J Am Osteopath Assoc. 2005; 105: S9-S14
- Are we close to the end of the primary tumor resection discussion for de novo stage IV BC?.Eur J Surg Oncol. 2019; 45: 81-82
- Does local surgery have a role in the management of stage IV breast cancer?.Eur J Surg Oncol. 2003; 29: 17-19
- Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988-2003 SEER data.Ann Surg Oncol. 2007; 14: 2187-2194
- 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
- Meta-analysis to determine if surgical resection of the primary tumour in the setting of stage IV breast cancer impacts on survival.Ann Surg Oncol. 2013; 20: 2828-2834
- Primary tumor resection improves the survival of younger patients with metastatic breast cancer.Oncol Rep. 2009; 21: 827-832
- Does aggressive local therapy improve survival in metastatic breast cancer?.Surgery. 2002; 132: 620-627
- Surgery and survival in patients with stage IV breast cancer.Breast J. 2019; 25: 644-653
- Surgical approach in the oligometastatic patient.Ann Transl Med. 2018; 6: 94
- A review of ongoing trials of stereotactic ablative radiotherapy for oligometastatic cancers: where will the evidence lead?.Front Oncol. 2019; 9: 543
- NCCN clinical practice guidelines in oncology: colon cancer, version 2.2020.(Available at:) (Accessed: July 20, 2020)
- The National Cancer Data Base: a powerful initiative to improve cancer care in the United States.Ann Surg Oncol. 2008; 15: 683-690
- Locoregional surgical treatment improves the prognosis in primary metastatic breast cancer patients with a single distant metastasis except for brain metastasis.Breast. 2019; 45: 104-112
- Surgical treatment of bone metastases in patients with breast cancer.Clin Orthop Relat Res. 2002; 396: 191-196
- Using the National Cancer Data Base for quality evaluation to assess adherence to treatment guidelines for nonmetastatic inflammatory breast cancer.Cancer. 2017; 123: 2618-2625
- Adherence to stage-specific treatment guidelines for patients with colon cancer.J Clin Oncol. 2012; 30: 972-979
- Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer.Cancer. 2017; 123: 2651-2660
- NCCN clinical practice guidelines in oncology: breast cancer, version 2.2020.(Available at:)
- 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
- A prospective analysis of surgery and survival in stage IV breast cancer (TBCRC 013).J Clin Oncol. 2016; 34: 1006
- Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial.Cancer Res. 2020; 80: P1-20-01
- Early surgery or standard palliative therapy in treating patients with stage IV breast cancer. NCI, 2011.(Available at:)
- A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: a trial of the ECOG-ACRIN Research Group (E2108).J Clin Oncol. 2020; 38: LBA2
- 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
- Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial.Lancet. 2019; 393: 2051-2058
Article info
Publication history
Published online: August 18, 2020
Accepted:
August 13,
2020
Received in revised form:
August 3,
2020
Received:
May 27,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
