Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis

Abstract

Background Breast surgery for stage IV breast cancer remains controversial. The aim of this study was to investigate the impact of breast surgery on survival of stage IV breast cancer patients based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Methods In total, 13,034 patients were selected and divided into surgery and non-surgery groups. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was utilized to achieve balanced covariates across different groups. One-to-one (1:1) PSM was conducted to construct a matched sample consisting of pairs of surgery and non-surgery subjects. Breast cancer-specific survival (BCSS) and overall survival (OS) of the two groups were assessed by Kaplan–Meier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed. Results Patients treated with breast surgery were more likely to be younger, smaller tumor size, more advanced nodal status, higher histology grade and higher proportion of bone-only metastasis. Those who received chemotherapy and radiotherapy also tended to be treated with surgery. After adjustment for potential confounders, breast surgery group exhibited a better survival both in BCSS (HR = 0.557, 95% CI [0.523–0.594], p < 0.001) and OS (HR = 0.571, 95% CI [0.537–0.607], p < 0.001). After propensity score matching, the surgery and non-surgery group consisted of 2,269 patients respectively. The median survival time was 43 months for the surgery group and 27 months for the non-surgery group. Kaplan–Meier curves indicated that breast surgery could clearly improve both the BCSS and OS for patients with stage IV breast cancer. On multivariate analysis, surgery group was associated with a better survival compared with the non-surgery group (BCSS: HR = 0.542, 95% CI [0.499–0.589], p < 0.001; OS: HR = 0.555, 95% CI [0.512–0.601], p < 0.001). Furthermore, this survival advantage persisted in all subgroups irrespective of age, race, tumor size, nodal status, histology grade, molecular subtype, chemotherapy status, radiotherapy status or status of distant metastasis. Conclusion Our study provided additional evidence that patients with stage IV breast cancer could benefit from breast surgery and it might play a more important role in multimodality therapy.

Metastatic Pattern Discriminates Survival Benefit of Type of Surgery in Patients With De Novo Stage IV Breast Cancer Based on SEER Database

“…In this large cohort, an improved OS was found in the surgery group compared with the non-surgery group even after propensity score matching (HR = 0.68, 95% CI [0.63–0.72], p < 0.001) ( 27 ). The above-mentioned findings are in consistent with the previous studies showing that surgical procedure has a key role in de novo stage IV BC therapy ( 17 , 25 , 26 , 28 , 29 ) as surgery may substantially reduce overall tumor burden and improve survival by activating immune responsiveness ( 30 , 31 ). But other studies held different opinions.…”

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“…In this large cohort, an improved OS was found in the surgery group compared with the nonsurgery group even after propensity score matching (HR = 0.68, 95% CI [0.63-0.72], p < 0.001) (27). The above-mentioned findings are in consistent with the previous studies showing that surgical procedure has a key role in de novo stage IV BC therapy (17,25,26,28,29) as surgery may substantially reduce overall tumor burden and improve survival by activating immune responsiveness (30,31). But other studies held different opinions.…”

“…A previous study based on the SEER database (1998-2011) suggested a survival benefit with a surgical procedure (median OS, 34 months for surgery vs. 18 months for non-surgery), but the data about HER2 status in this study was incomplete (24). However, other recent studies based on the SEER database (2010-2015), the information about HER2 status was integral, also proposed that surgery could improve OS and BCSS in patients with stage IV BC (25,26). Moreover, one research based on the NCDB database also highlighted that surgery could benefit patients with stage IV BC.…”

Locoregional Treatment in De Novo Metastatic Breast Cancer: A Retrospective Cohort Study

“…With respect to the survival effects of LRT in patients with dnMBC, retrospective studies have shown the potential survival bene ts [8,15,[39][40][41][42][43][44][45] , while prospective studies have revealed mixed results [29] . Currently, three published prospective studies have assessed the impact of LRT in dnMBC.…”

“…The latest research from the NCDB (2003-2012) demonstrated that among women alive 1 year after a diagnosis of metastatic breast cancer, surgical resection of the primary tumor was associated with improved survival, regardless of treatment sequence [8] . Another recent study based on the SEER database (2010-2015) proposed a survival advantage with surgical intervention (median OS, 43 months for surgery vs. 27 months for non-surgery) [45] . Similarly, in our study, the median OS of the two groups was 42 months vs. 22 months, respectively.…”