Effect of Surgery at Primary and Metastatic Sites in Patients With Stage IV Breast Cancer

Bilani, Nadeem; Elson, Leah; Liang, Hong; Elimimian, Elizabeth Blessing; Nahleh, Zeina

doi:10.1016/j.clbc.2020.08.008

Cited by 16 publications

(22 citation statements)

References 23 publications

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“…Some studies managed to balance the baseline characteristics to overcome selection bias by paired design or propensity score matching. Of the nine studies included, three were unmatched studies (20,21,24), another six were matched studies (22,23,(25)(26)(27)(28), with four of which reporting the comparing outcomes before matching (22,23,25,26). Finally, seven unmatched cohorts and six matched cohorts were included in the pooled analysis.…”

Section: Combined Results Of the Matched/unmatched Cohortsmentioning

confidence: 99%

“…This was because most of the related studies published before 2020 were single-arm case series, with no comparing results reported. It was the five related original articles with comparing results published after 2020 that made pooled analysis possible ( 20 – 24 ). Therefore, our conclusion is the highest level of evidence to date on the prognostic benefits of surgical treatment for isolated BCLM, since there are no relevant randomized controlled trials published until now.…”

Section: Discussionmentioning

confidence: 99%

“…After deduplicating titles and screening abstracts, 28 full-texts were reviewed, of which further 19 studies were excluded for various reasons (Figure 1). Ultimately, nine studies (20)(21)(22)(23)(24)(25)(26)(27)(28) were included in this meta-analysis. Characteristics of included studies, matching covariates, and study quality evaluated using (23) included patients with non-osseous extrahepatic metastases in the surgical cohort, which accounted for 9.6%, but no patients in the systemic cohort had any non-osseous extrahepatic metastases.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Surgical treatment was performed by LR in six studies(21)(22)(23)(24)(25)28), by LR or RFA in two studies(20,26), and by RFA in one(27). The characteristics of patients with isolated BCLM in the study cohorts were summarized in Tables 2, 3.…”

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confidence: 99%

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Survival Benefit of Surgical Treatment Added Into Systemic Treatment for Isolated Breast Cancer Liver Metastases: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Compared with systemic treatment alone, whether surgical treatment combined with systemic treatment can improve survival outcomes of patients with isolated breast cancer liver metastases (BCLM) is still controversial. This meta-analysis was designed to evaluate the efficacy of surgical treatment for patients with isolated BCLM.Methods: A systematic search of PubMed, Embase, and Cochrane Library up to May 13, 2021 was conducted for relevant studies. The primary outcome was overall survival. The meta-analysis was performed using R software. The quality of the pooled study was assessed using the Newcastle-Ottawa scale. The publication bias was evaluated by funnel plots and Begg's and Egger's tests. Fixed- and random-effects models were applied according to heterogeneity.Results: 9 retrospective studies involving 13 cohorts (7 unmatched cohorts and 6 matched cohorts) were included in this study. The surgical cohorts had better overall survival than the systemic cohorts in the pooled analysis of all the included studies, in the subgroup analysis of liver resection, and in the subset of the matched cohorts.Conclusions: Compared with systemic treatment alone, surgical treatment combined with systemic treatment was proven to be associated with superior survival outcomes, which should be considered in selected patients with isolated BCLM.

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Section: Combined Results Of the Matched/unmatched Cohortsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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confidence: 99%

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Survival Benefit of Surgical Treatment Added Into Systemic Treatment for Isolated Breast Cancer Liver Metastases: A Systematic Review and Meta-Analysis

et al. 2021

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“…'metastasectomy') in patients with limited metastasis was associated with improved OS in stage IV BC [8]. We also showed that metastasectomy alone, without primary site surgical resection, was associated with improved OS compared to no surgery [9]. Retrospective and single-arm prospective studies have investigated the survival benefit of locoregional therapy in lung [10e12], prostate [13], and colorectal cancer [14].…”

Section: Introductionmentioning

confidence: 95%

Metastasectomy versus radiation of secondary sites in stage IV breast cancer: Analysis from a national cancer registry

et al. 2021

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Locoregional therapy at primary or secondary sites in breast cancer may be associated with improved survival as compared to systemic therapy alone. We explored the sociodemographic and clinicopathologic factors associated with the use of radiation versus surgical resection of metastatic sites (metastasectomy) in patients with de novo stage IV breast cancer, followed by the associated overall survival. Methods: We sampled the National Cancer Database for patients with de novo stage IV breast cancer, (2010e2017) and described cohort's characteristics using univariate analyses. We identified 5 subgroups based on malignant site involvement: 1. Bone only, 2. Brain only, 3. Liver only, 4. Lung only, and 5. Metastasis involving >1 site. Kaplan-Meier modeling with log-rank testing and multivariate Cox Regression analysis were used to explore differences in overall survival between those that received radiation at secondary sites and those that underwent metastasectomy. Results: N ¼ 22,749patients were included in this analysis. Radiation (81.2%) was used more commonly than metastasectomy (28.8%). Metastasectomy was associated with better median overall survival across all 5 cohorts (p < .001), with the survival benefit being the most pronounced with lung only (OS: 56.9 months; HR 0.8, 95% CI 0.7e0.9, p ¼ .032), or liver only (OS: 41.6 months; HR: 0.9; 95% CI: 0.7e1.1, p < .001) metastasis. Conclusion: Metastasectomy in patients with de novo stage IV breast cancer may be associated with improved overall survival as compared to radiation of secondary lesions, particularly in those with only liver or lung involvement. Prospective randomized controlled trials investigating surgical resection of metastatic sites in patients with breast cancer are warranted.

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Association of Brain Metastases With Survival in Patients With Limited or Stable Extracranial Disease

Gaebe

Zulfiqar

et al. 2023

JAMA Netw Open

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ImportanceIntracranial metastatic disease (IMD) is a severe complication of cancer with profound prognostic implications. Patients with IMD in the setting of limited or stable extracranial disease (IMD-SE) may represent a unique and understudied subset of patients with IMD with superior prognosis.ObjectiveTo evaluate overall survival (OS), progression-free survival (PFS), and intracranial PFS (iPFS) in patients with IMD-SE secondary to any primary cancer.Data SourcesRecords were identified from MEDLINE, EMBASE, CENTRAL, and gray literature sources from inception to June 21, 2021.Study SelectionStudies in English reporting OS, PFS, or iPFS in patients with IMD-SE (defined as IMD and ≤2 extracranial metastatic sites) and no prior second-line chemotherapy or brain-directed therapy were selected.Data Extraction and SynthesisAuthor, year of publication, type of study, type of primary cancer, and outcome measures were extracted. Random-effects meta-analyses were performed to estimate effect sizes, and subgroup meta-analysis and metaregression were conducted to measure between-study differences in February 2022.Main Outcomes and MeasuresThe primary end point was OS described as hazard ratios (HRs) and medians for comparative and single-group studies, respectively. Secondary end points were PFS and iPFS.ResultsOverall, 68 studies (5325 patients) were included. IMD-SE was associated with longer OS (HR, 0.52; 95% CI, 0.39-0.70) and iPFS (HR, 0.63; 95% CI, 0.52-0.76) compared with IMD in the setting of progressive extracranial disease. The weighted median OS estimate for patients with IMD-SE was 17.9 months (95% CI, 16.4-22.0 months), and for patients with IMD-PE it was 8.0 months (95% CI, 7.2-12.8 months). Pooled median OS for all patients with IMD-SE was 20.9 months (95% CI, 16.35-25.98 months); for the subgroup with breast cancer it was 20.2 months (95% CI, 10.43-38.20 months), and for non–small cell lung cancer it was 27.5 months (95% CI, 18.27-49.66 months). Between-study heterogeneity for OS and iPFS were moderate (I2 = 56.5%) and low (I2 = 0%), respectively.Conclusions and RelevanceIn this systematic review and meta-analysis of patients with IMD-SE, limited systemic disease was associated with improved OS and iPFS. Future prospective trials should aim to collect granular information on the extent of extracranial disease to identify drivers of mortality and optimal treatment strategies in patients with brain metastases.

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Effect of Surgery at Primary and Metastatic Sites in Patients With Stage IV Breast Cancer

Cited by 16 publications

References 23 publications

Survival Benefit of Surgical Treatment Added Into Systemic Treatment for Isolated Breast Cancer Liver Metastases: A Systematic Review and Meta-Analysis

Survival Benefit of Surgical Treatment Added Into Systemic Treatment for Isolated Breast Cancer Liver Metastases: A Systematic Review and Meta-Analysis

Metastasectomy versus radiation of secondary sites in stage IV breast cancer: Analysis from a national cancer registry

Association of Brain Metastases With Survival in Patients With Limited or Stable Extracranial Disease

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