Effect of Surgery at Primary and Metastatic Sites in Patients With Stage IV Breast Cancer |
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| Authors: | Nadeem Bilani Leah Elson Hong Liang Elizabeth Blessing Elimimian Zeina Nahleh |
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| Institution: | 1. Department of Surgery, University Hospital of North Midlands, Stoke on Trent, UK;2. Department of Radiology, University Hospital of North Midlands, Stoke on Trent, UK;3. Department of Pathology, University Hospital of North Midlands, Stoke on Trent, UK;4. Department of Medicine, University of Keele, Staffordshire, UK;1. Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL;2. Breast Care Center, Orlando Health - UF Health Cancer Center, Orlando, FL;3. Present affiliation: Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH;4. Present affiliation: Tehran University of Medical Sciences, Tehran, Iran;1. Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China;2. Deepwise AI Lab, Beijing, China;1. Department of Medicine and Surgery and Translational Medicine, “Sapienza” University of Rome, Radiotherapy Oncology, St Andrea Hospital, Rome, Italy;2. Department of Statistical Sciences, “Sapienza” University of Rome, Rome, Italy;3. Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Hearth Failure Unit, St Andrea Hospital, Rome, Italy;4. Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, St Andrea Hospital, Rome, Italy;1. Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;2. Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;3. Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;4. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;5. Centre for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy;6. UOC Oncologia Medica, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy;7. Oncologia Medica e CPDO, ASSL di Olbia-ATS Sardegna, Olbia, Italy;8. SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy |
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| Abstract: | BackgroundThere 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 MethodsThis 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.ResultsA 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.ConclusionIn patients with metastasis to only one site, metastasectomy was associated with better OS when that site was the liver, lung, or brain. |
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| Keywords: | Metastatic breast cancer Surgery Survival |
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