Surgical Resection of the Primary Tumor in Women With De Novo Stage IV Breast Cancer

Lane, Whitney O.; Thomas, Samantha M.; Blitzblau, Rachel; Plichta, Jennifer K.; Rosenberger, Laura H.; Fayanju, Oluwadamilola M.; Hyslop, Terry; Hwang, E. Shelley; Greenup, Rachel A.

doi:10.1097/sla.0000000000002621

Cited by 97 publications

(100 citation statements)

References 21 publications

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“…29 Many previous works reported no survival gain from surgery with positive margins in metastatic setting. 25,30,31 However, our study presented no survival difference between women receiving mastectomy or lumpectomy, and therefore it could be speculated that many patients may obtain clear margins after lumpectomy. Similarly, Lane et al 25 reported a positive margin rate of ,20% for patients receiving lumpectomy or mastectomy based on a national database.…”

Section: Discussionmentioning

confidence: 52%

“…25,30,31 However, our study presented no survival difference between women receiving mastectomy or lumpectomy, and therefore it could be speculated that many patients may obtain clear margins after lumpectomy. Similarly, Lane et al 25 reported a positive margin rate of ,20% for patients receiving lumpectomy or mastectomy based on a national database. However, we cannot determine whether more aggressive surgery (simple of modified mastectomy) can provide additional benefits.…”

Section: Discussionmentioning

confidence: 52%

“…Palliative systemic therapy is usually considered the therapeutic backbone for patients with metastatic breast cancer. 12,14 Despite this, studies have reported that approximately 40% of women receive locoregional surgery and some patients desire a complete excision of primary tumor for psychosocial reasons, [23][24][25] and many other reports reached an entirely different conclusion regarding primary tumor surgery versus systemic therapy. A Turkish study (MF07-01) reported a 34% higher overall survival for patients receiving locoregional surgery combined with chemotherapy compared with those receiving chemotherapy In both the univariate and multivariate analyses, a different treatment modality was selected as the reference category to perform the pairwise comparison ("no treatment" for Model 1, "surgery only" for Model 2, and "chemo only" for Model 3).…”

Section: Discussionmentioning

confidence: 99%

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Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

Lin

Ding

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Patients with de novo metastatic breast cancer (MBC) constitute a heterogeneous group with different clinicopathologic characteristics and survival outcomes. Despite controversy regarding its prognostic value, primary tumor surgery may improve survival for selected patients. Patients and Methods: Patients with de novo MBC were identified using the SEER database and were then divided randomly into training and validation sets. A Fine-Gray competing risks model was developed to identify the variables associated with increased cancer-specific mortality in the training set. The M1 subdivision system was established based on the independent prognostic factors. Cumulative incidence curves were estimated and compared using Gray’s test. Results: Involvement of brain or liver and number of metastatic sites were identified as independent prognostic factors in multivariate analysis. The M1 category was subdivided into 3 subcategories: M1a, single site involvement except brain and liver; M1b, liver involvement only, or multiple site involvement except brain and liver; and M1c, brain involvement regardless of number of metastatic sites, or liver and other sites involvement except brain (M1b vs M1a: subdistribution hazard ratio [SHR], 1.48; 95% CI, 1.29–1.68; M1c vs M1a: SHR, 2.45; 95% CI, 2.18–2.75). Patients with the M1a subtype benefited most from primary tumor surgery in the adjusted competing risks model (M1a: SHR, 0.57; 95% CI, 0.48–0.67, M1b: SHR, 0.62; 95% CI, 0.47–0.83, and M1c: SHR, 0.59; 95% CI, 0.44–0.80), whereas benefits conferred by treatment with chemotherapy alone increased with the upstaging of metastatic disease (M1a: SHR, 0.72; 95% CI, 0.62–0.83, M1b: SHR, 0.54; 95% CI, 0.44–0.68, and M1c: SHR, 0.53; 95% CI, 0.45–0.61). Conclusions: Subdivision of M1 stage facilitates prognosis prediction and treatment planning for patients with de novo MBC. Treatment offered should be decided in a coordinated multidisciplinary setting. Primary tumor surgery may play an important role in the management of selected patients.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

Lin

Ding

et al. 2019

Journal of the National Comprehensive Cancer Network

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“…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. Metastatic breast cancer is still considered as a systemic disease and local therapy would only have little impact on outcomes (Lane et al, 2019). The primary aim of treatment is to alleviate symptoms, improve the quality of life and prolong survival.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Huang

Zeng

et al. 2020

PeerJ

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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.

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“…Metastatic breast cancer is still considered as a systemic disease and local therapy would only have little impact on outcomes [19]. The primary aim of treatment is to alleviate symptoms, improve the quality of life and prolong survival.…”

Section: Discussionmentioning

confidence: 99%

Peer Review #2 of "Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis (v0.1)"

2020

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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.

show abstract

Surgical Resection of the Primary Tumor in Women With De Novo Stage IV Breast Cancer

Cited by 97 publications

References 21 publications

Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

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

Peer Review #2 of "Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis (v0.1)"

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