Locoregional surgical treatment improves the prognosis in primary metastatic breast cancer patients with a single distant metastasis except for brain metastasis

Li, Xin; Huang, Run; Ma, Lisi; Liu, Sixuan; Zong, Xiangyun

doi:10.1016/j.breast.2019.03.006

Cited by 42 publications

(41 citation statements)

References 27 publications

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“…In the subgroup analysis, a multivariate cox analysis indicated that receiving surgery improved the OS and BCSS in almost all subgroups including patients with brain metastasis. This was different from a recent study implying that breast surgery provided no survival advantage for MBC patients with brain metastasis (29).…”

Section: Discussioncontrasting

confidence: 99%

Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Zheng

Zhong

et al. 2020

Front. Oncol.

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Objective: Recently, performing locoregional surgical treatment still remains debatable in patients with metastatic breast cancer (MBC). Current study aimed to develop prognostic nomograms for predicting the long-term survival in MBC patients with or without surgical intervention, thereby assisting clinicians in making individualized choice.Methods: The training set included 5173 patients who were diagnosed with MBC in 2010-2013 from the Surveillance, Epidemiology, and End Results Program, while the validation set comprised 2924 patients diagnosed in 2014-2015. Multivariant Cox hazard model was applied to determine the independent risk factors for overall survival (OS) and breast cancer specific survival (BCSS). Then, individualized pre-and postoperative nomograms for predicting 1-or 3-year survival probabilities were constructed accordingly. Internal and external validations were conducted to determine the accuracy of these nomograms by calculating concordance index (C-index) and plotting calibration curves.Results: The survival analysis indicated that surgical management conferred improved OS and BCSS in patients with metastatic breast cancer. Age, T stage, grade, distant metastatic site, ER, PR and HER2 status, radiation, and chemotherapy were independent risk factors for OS and BCSS both in surgery and non-surgery group. All these factors were subsequently incorporated into the nomogram which showed acceptable predictive capabilities with C-index range of 0.65-0.80 both in training set and external validation set. In addition, a preoperative nomogram incorporating variables capable of being determined before surgery was also built with C-index above 0.70 both in training and validation set. Conclusion:Surgical management in patients with metastatic breast cancer suggests a potential survival advantage. In addition, these well-validated pre-and postoperative nomograms may provide a useful tool to assist clinicians in treatment decision-making and in evaluating patients' long term prognosis.

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Section: Discussioncontrasting

confidence: 99%

Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Zheng

Zhong

et al. 2020

Front. Oncol.

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“…The 5-year OS could reach 50% in hormone receptor (HoR)-positive (+) tumors, but the 3year breast cancer-specific survival (BCSS) and OS for de novo stage IV triple-negative breast cancer are still lower than 20% 5,6 . Further, the median OS for human epidermal growth factor receptor-2 positive (HER2+) tumors in this population has also been reported to reach 60 months after trastuzumab-based therapy 7 , and the prognosis of de novo stage IV disease was found to be better than those with recurrent tumors [8][9][10] .…”

Section: Introductionmentioning

confidence: 83%

Incorporation of biologic factors for the staging of de novo stage IV breast cancer

Lian

Wang

et al. 2020

npj Breast Cancer

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This study aimed to investigate the prognostic value of biological factors, including histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status in de novo stage IV breast cancer. Based on eligibility, patient data deposited between 2010 and 2014 were collected from the surveillance, epidemiology, and end results database. The receiver operating characteristics curve, Kaplan–Meier analysis, and Cox proportional hazard analysis were used for analysis. We included 8725 patients with a median 3-year breast cancer-specific survival (BCSS) of 52.6%. Higher histologic grade, HER2-negative, ER-negative, and PR-negative disease were significantly associated with lower BCSS in the multivariate prognostic analysis. A risk score staging system separated patients into four risk groups. The risk score was assigned according to a point system: 1 point for grade 3, 1 point if hormone receptor-negative, and 1 point if HER2-negative. The 3-year BCSS was 76.3%, 64.5%, 48.5%, and 23.7% in patients with 0, 1, 2, and 3 points, respectively, with a median BCSS of 72, 52, 35, and 16 months, respectively (P < 0.001). The multivariate prognostic analysis showed that the risk score staging system was an independent prognostic factor associated with BCSS. Patients with a higher risk score had a lower BCSS. Sensitivity analyses replicated similar findings after stratification according to tumor stage, nodal stage, the sites of distant metastasis, and the number of distant metastasis. In conclusion, our risk score staging system shows promise for the prognostic stratification of de novo stage IV breast cancer.

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“…However, four recent randomized trials that investigated prognosis after surgery in de novo stage IV breast cancer reported conflicting results (8)(9)(10)(11). Several retrospective studies have shown a survival advantage with locoregional treatment, including surgery or radiotherapy to the primary site (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The rationale for proceeding with additional surgery or radiotherapy includes the possibility of increasing the effectiveness of chemotherapy, reducing the total tumor burden, restoring immunity, eliminating breast cancer stem cells, and decreasing the likelihood of resistant disease, which may lower the metastatic potential of the primary tumor (22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

et al. 2020

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Introduction To investigate the effect of local treatment strategy on survival outcome in de novo stage IV breast cancer patients who received chemotherapy. Methods We identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan–Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses. Results We identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM. Conclusions Compared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with de novo stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.

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Locoregional surgical treatment improves the prognosis in primary metastatic breast cancer patients with a single distant metastasis except for brain metastasis

Cited by 42 publications

References 27 publications

Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Individualized Prediction of Survival Benefit From Locoregional Surgical Treatment for Patients With Metastatic Breast Cancer

Incorporation of biologic factors for the staging of de novo stage IV breast cancer

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis

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