Impact of Breast Surgery in Primary Metastasized Breast Cancer

Fitzal, Florian; Bjelic‐Radisic, Vesna; Knauer, Michael; Steger, G.; Hubalek, Michael; Balić, Marija; Singer, Christian F.; Bartsch, Rupert; Schrenk, Peter; Soelkner, Lidija; Greil, Richard; Gnant, Michael

doi:10.1097/sla.0000000000002771

Cited by 147 publications

(109 citation statements)

References 27 publications

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“…However, not all patients can obtain a survival benefit from locoregional therapy. The ABCSG-28 trial did not indicate a survival benefit for locoregional surgery in de novo metastatic breast cancer (29). Another openlabeled randomized controlled trial in India also identified that breast operations could not prolong survival in patients with primary metastasis (30).…”

Section: Discussionmentioning

confidence: 99%

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

Wang

Sun

et al. 2020

Front. Oncol.

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Background and Aims: This research aimed to construct a novel model for predicting overall survival (OS) and surgical benefit in triple-negative breast cancer (TNBC) patients with de novo distant metastasis.Methods: We collected data from the Surveillance, Epidemiology, and End Results (SEER) database for TNBC patients with distant metastasis between 2010 and 2016. Patients were excluded if the data regarding metastatic status, follow-up time, or clinicopathological information were incomplete. Univariate and multivariate analyses were applied to identify significant prognostic parameters. By integrating these variables, a predictive nomogram and risk stratification model were constructed and assessed with C-indexes and calibration curves.Results: A total of 1,737 patients were finally identified. Patients enrolled from 2010 to 2014 were randomly assigned to two cohorts, 918 patients in the training cohort and 306 patients in the validation cohort I, and 513 patients enrolled from 2015 to 2016 were assigned to validation cohort II. Seven clinicopathological factors were included as prognostic variables in the nomogram: age, marital status, T stage, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The C-indexes were 0.72 [95% confidence interval [CI] 0.68-0.76] in the training cohort, 0.71 (95% CI 0.68-0.74) in validation cohort I and 0.71 (95% CI 0.67-0.75) in validation cohort II. Calibration plots indicated that the nomogram-based predictive outcome had good consistency with the recoded prognosis. A risk stratification model was further generated to accurately differentiate patients into three prognostic groups. In all cohorts, the median overall survival time in the low-, intermediate-and high-risk groups was 17.0 months (95% CI 15.6-18.4), 11.0 months (95% CI 10.0-12.0), and 6.0 months (95% CI 4.7-7.3), respectively. Locoregional surgery improved prognosis in both the low-risk [hazard ratio [HR] 0.49, 95% CI 0.41-0.60, P < 0.0001] and intermediate-risk groups (HR 0.55, 95% CI 0.46-0.67, P < 0.0001), but not in high-risk group (HR 0.73, 95% CI 0.52-1.03, P = 0.068). All stratified groups could prognostically benefit from chemotherapy (low-risk group: HR 0.50, 95% CI 0.35-0.69, P < 0.0001; intermediate-risk group: HR 0.34, Wang et al.Predictive Model for Metastatic TNBC 95% CI 0.26-0.44, P < 0.0001; and high-risk group: HR 0.16, 95% CI 0.10-0.25, P < 0.0001). Conclusion:A predictive nomogram and risk stratification model were constructed to assess prognosis in TNBC patients with de novo distant metastasis; these methods may provide additional introspection, integration and improvement for therapeutic decisions and further studies.

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Section: Discussionmentioning

confidence: 99%

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

Wang

Sun

et al. 2020

Front. Oncol.

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“…Survival data have been reported previously) [13]. Surgery did not provide an OS benefit (34.6 months vs 54.8 months, p = 0.267; HR 0.691; 95% CI 0.358-1.333) or TTPd and TTPl ( HR 0.598, p = 0.0668; HR 0.933, p = 0.882) [13]. (Figure 2a und 2b) QoL assessment as predictor for OS and TTPd…”

Section: Resultsmentioning

confidence: 81%

“…Our trial, which was halted prematurely, indicated that primary surgery does not improve OS, TTPd or TTPl in women presenting with MBC [13].This makes QoL outcomes all the more important. Our results indicate that global health status, physical functioning, social functioning, and future perspective were predictors for OS and/or TTTd.…”

Section: Discussionmentioning

confidence: 87%

“…QoL assessments in these women are critical and many phase 3 trials in this population include QoL as a primary or secondary endpoint [18]. The ABCSG 28 is the third randomised trial evaluating the role of primary surgery in women with stage IV BC, but the first to report the impact of primary surgery prior to systemic therapy versus primary systemic therapy on QoL [13].Two previous randomised trials [7,12] of surgery vs. no surgery described oncologic outcomes; QoL data from one of these trials have been presented in abstract form [19].…”

Section: Discussionmentioning

confidence: 99%

“…(Consort diagram of the patients randomized to the ABCSG-28 Positive trial with QoL assessment is presented in Figure 1.) The ABCSG 28 [13] and the present analysis of QoL data adheres to CONSORT guidelines.…”

Section: Methodsmentioning

confidence: 99%

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Primary surgery versus no surgery in synchronous metastatic breast cancer: Patient-reported Quality-of-Life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial

Bjelic‐Radisic

Fitzal

Knauer

et al. 2019

Preprint

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Background: The ABCSG-28 trial compared primary surgery followed by systemic therapy versus primary systemic therapy without surgery in patients with de novo stage IV BC. The present report describes QoL results of this trial. Methods: 90 patients with primary operable MBC were randomised to surgery of the primary tumor followed by systemic therapy or to primary systemic therapy without surgery. QoL analyses covering the results at baseline, 6,12,18 and 24 months follow up of 79 (88%) patients, was assessed with the EORTC QLQ-C30 and QLQ-BR23 questionnaires. Results: There were no statistically significant differences in any of the scales of the QLQ-C30 and QLQ-BR23 questionnaires between the two groups over the time. Baseline global health status and physical functioning were predictors for OS (patients with a higher score lived longer (p=0.0250, p=0.0225; p=0.0355, p=0.0355)). Global health status, social functioning scale, breast symptoms and future perspective were predictors for longer TTPd (p=0.0244; p=0.0140, p=0.020; p=0.0438, p=0.0123). Patients in both arms reported significant improvement on the emotional functioning scale. Cognitive functioning decreased over time in both groups. Younger women had clinically relevant better physical and sexual functioning scores (p=0.039 and 0.024). Conclusion: Primary surgery does not improve nor alter QoL of patients with de novo stage IV BC. Global health status and physical functioning were predictors for OS and could be use as additional marker for prediction of OS and TTTd in patients with de novo stage IV BC.

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Distant Lymph Node Metastases From Breast Cancer—Is it Time to Review TNM Cancer Staging?

Zou

Deng

2021

JAMA Netw Open

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Using the Surveillance, Epidemiology, and End Results (SEER) registries database, Hong Pan et al 1 retrospectively analyzed 2033 patients who were diagnosed with breast cancer between 2010 and 2014. Patients were allocated into 3 cohorts, namely the distant lymph node metastases (DLNM) cohort, ipsilateral supraclavicular lymph node metastases (ISLM) cohort, and distant metastases (DLNM excluded) cohort. Their results revealed that 3-year breast cancer-specific survival rate (BCSS) and overall survival (OS) rate were similar between patients in the DLNM and ISLM cohorts.Author affiliations and article information are listed at the end of this article.

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Impact of Breast Surgery in Primary Metastasized Breast Cancer

Abstract: The prospective phase III trial ABCSG-28 (POSYTIVE) could not demonstrate an OS benefit for surgical resection of the primary in breast cancer patients presenting with de novo stage IV disease.

Cited by 147 publications

References 27 publications

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

Primary surgery versus no surgery in synchronous metastatic breast cancer: Patient-reported Quality-of-Life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial

Distant Lymph Node Metastases From Breast Cancer—Is it Time to Review TNM Cancer Staging?

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