Journal List > J Breast Cancer > v.13(1) > 1036246

Ahn, Han, Moon, Yu, Ko, Bae, Min, Kim, Im, Oh, Han, Ha, Chie, Oh, Youn, Kim, Hwang, and Noh: The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer

Abstract

Purpose

The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients.

Methods

We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients.

Results

Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041).

Conclusion

Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.

Figures and Tables

Figure 1
Unadjusted overall survival by surgery status. Kaplan-Meier survival curves for surgery and non-surgery groups are shown.
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Figure 2
Adjusted overall survival by surgery status. Survival curves are derived from Cox model, adjusted for surgery status, estrogen receptor, visceral metastases, number of metastatic sites and trastuzumab treatment.
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Table 1
Patient characteristics (n=198)
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ER=estrogen receptor; PR=progesteron receptor; Preop=preoperative.

Table 2
Surgical treatment variables
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SLNBx=sentinel lymph node biopsy only; ALND=axillary lymph node dissection; RM=resection margin.

Table 3
Univariate analysis for overall survival in stage IV breast cancer
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CI=confidence interval; ER=estrogen receptor.

Table 4
Multivariate analysis for overall survival in stage IV breast cancer*
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*Variables adjusted in Cox model were surgery, estrogen receptor (ER), visceral metastases, number of metastases, and trastuzumab treatment.

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Eui Kyu Chie
https://orcid.org/http://orcid.org/0000-0003-2027-7472

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