Improved Survival After Primary Tumor Surgery in Metastatic Breast Cancer

Warschkow, René; Güller, Ulrich; Tarantino, Ignazio; Cerny, Thomas; Schmied, Bruno M.; Thuerlimann, Beat; Joerger, Markus

doi:10.1097/sla.0000000000001302

Cited by 78 publications

(62 citation statements)

References 42 publications

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“…Our findings are consistent with many previously published population‐based and single‐institution retrospective studies,( reporting improved outcome with primary tumor resection in stage IV breast cancer at presentation. Retrospective studies including our study are associated with several limitations, such as inability to control for selection bias.…”

Section: Discussionsupporting

confidence: 92%

“…Our study results indicating benefit from PTR are consistent with previous population‐based studies, but included a broader time period (until 2011), and also highlights temporal trend of overall decrease in PTR for metastatic breast cancer along with improved survival toward later decades, attributed most likely to better imaging, patient selection and improvement in systemic therapy, and surgical techniques . Retrospective studies are overwhelmingly suggesting subset of metastatic breast cancer will benefit from surgical resection of primary tumor.…”

Section: Discussionsupporting

confidence: 88%

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Primary tumor resection in metastatic breast cancer: A propensity-matched analysis, 1988-2011 SEER data base

et al. 2018

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Primary tumor resection (PTR) in metastatic breast cancer is not a standard treatment modality, and its impact on survival is conflicting. The primary objective of this study was to analyze impact of PTR on survival in metastatic patients with breast cancer. A retrospective study of metastatic patients with breast cancer was conducted using the 1988-2011 Surveillance, Epidemiology, and End Results (SEER) data base. Cox proportional hazards regression models were used to evaluate the relationship between PTR and survival and to adjust for the heterogeneity between the groups, and a propensity score-matched analysis was also performed. A total of 29 916 patients with metastatic breast cancer were included in the study, and 15 129 (51%) of patients underwent primary tumor resection, and 14 787 (49%) patients did not undergo surgery. Overall, decreasing trend in PTR for metastatic breast cancer in last decades was noted. Primary tumor resection was associated with a longer median OS (34 vs 18 months). In a propensity score-matched analysis, prognosis was also more favorable in the resected group (P = .0017). Primary tumor resection in metastatic breast cancer was associated with survival improvement, and the improvement persisted in propensity-matched analysis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Primary tumor resection in metastatic breast cancer: A propensity-matched analysis, 1988-2011 SEER data base

et al. 2018

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“…Similar to our research, several analysis have also reported that primary tumour surgery has a favourable prognostic impact in stage IV breast cancer patients171833. We used a Cox proportional regression model by adjusting for all the prognostic factors and demonstrated an obvious benefit of primary tumour removal.…”

Section: Discussionsupporting

confidence: 69%

Impact of molecular subtypes on metastatic breast cancer patients: a SEER population-based study

Gong

Liu

et al. 2017

Sci Rep

171

173

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To investigate the significance and impact of molecular subtyping stratification on metastatic breast cancer patients, we identified 159,344 female breast cancer patients in the Surveillance, Epidemiology and End Results (SEER) database with known hormone receptor (HoR) and human epidermal growth factor receptor 2 (HER2) status. 4.8% of patients were identified as having stage IV disease, and were more likely to be HER2+/HoR−, HER2+/HoR+, or HER2−/HoR−. Stage IV breast cancer patients with a HER2+/HoR+ status exhibited the highest median overall survival (OS) (44.0 months) and those with a HER2−/HoR− status exhibited the lowest median OS (13.0 months). Patients with a HER2−/HoR+ status had more bone metastasis, whereas patients with a HER2+/HoR− status had an increased incidence of liver metastasis. Brain and lung metastasis were more likely to occur in women with a HER2−/HoR− status. The multivariable analysis revealed a significant interaction between single metastasis and molecular subtype. No matter which molecular subtype, women who did not undergo primary tumour surgery had worse survival than those who experienced primary tumour surgery. Collectively, our findings advanced the understanding that molecular subtype might lead to more tailored and effective therapies in metastatic breast cancer patients.

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“…Retrospective observational study is prior than prospective randomized trials because it has no selection bias by entering good performance and small tumor patients possibly benefitting most from primary surgery in such trials [32]. This retrospective study used SEER registry data.…”

Section: Discussionmentioning

confidence: 99%

Benefits of local tumor excision and pharyngectomy on the survival of nasopharyngeal carcinoma patients: a retrospective observational study based on SEER database

Sun

Huang

et al. 2017

J Transl Med

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BackgroundThere is ongoing debate about surgery of primary site in nasopharyngeal carcinoma patients.Methods3919 patients with nasopharyngeal carcinoma identified in the SEER registry between 2004 and 2013. The benefit of surgery of primary nasopharynx tumor site on overall and cancer-specific survival was assessed by risk-adjusted multivariate Cox proportional hazard regression and propensity score matching modeling.ResultsSurgery was marginally associated with better overall survival (hazard ratio (HR) = 0.816, 95% CI 0.656–1.015, p = 0.07) and cancer-specific survival (HR = 0.749, 95% CI 0.552–1.018, p = 0.06) in the propensity score model. Among 398 cases who underwent primary site surgery, 282 (70.85%) received local tumor excision and 79 (20.31%) received pharyngectomy. Local tumor excision and pharyngectomy had almost the same effect on survival in propensity score matching analysis. The benefit was significant in subgroups of white, age <60 year, and patients with T3, N1, M0, AJCC stage III, or moderately differentiated tumors. Further survival analysis showed surgery to promote survival in both radiotherapy and non-radiotherapy patients.ConclusionThis is the first population-based analysis using propensity score model to provide evidence of a positive impact of surgery on survival in nasopharyngeal carcinoma. Moreover, surgery demonstrated the significant benefit in subgroups of patients with specific clinical characteristics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-017-1204-x) contains supplementary material, which is available to authorized users.

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Improved Survival After Primary Tumor Surgery in Metastatic Breast Cancer

Cited by 78 publications

References 42 publications

Primary tumor resection in metastatic breast cancer: A propensity-matched analysis, 1988-2011 SEER data base

Primary tumor resection in metastatic breast cancer: A propensity-matched analysis, 1988-2011 SEER data base

Impact of molecular subtypes on metastatic breast cancer patients: a SEER population-based study

Benefits of local tumor excision and pharyngectomy on the survival of nasopharyngeal carcinoma patients: a retrospective observational study based on SEER database

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