Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival
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Purpose Retrospective analyses suggest patients with stage IV breast cancer who undergo breast surgery have improved survival. We sought to determine whether surgery and other clinical and staging factors affected overall survival. Methods We performed a review of our prospectively maintained database of patients who presented with stage IV breast cancer between 1998 and 2005. We compared survival between women who received therapeutic surgery to the breast (S) versus those who did not (NS). Results Of the 147 women who presented with stage IV breast carcinoma, 61 (41%) underwent mastectomy or lumpectomy. Median overall survival unadjusted was 3.52 years for S versus 2.36 years for NS (P = 0.093). ER and Her2neu status were positive predictors of survival (HR: 0.191 and 0.285 P < 0.0001); CNS and liver metastases were adverse predictors (HR: 2.05 and 1.59 P = 0.015 P = 0.059). On multivariate survival was significantly superior in the surgery group (HR: 0.47 P = 0.003 mean 4.13 years versus 2.36 years). In those undergoing surgery, 36 women were diagnosed with metastatic disease postoperatively and 25 preoperatively. These groups had median survival of 4.0 years and 2.4 years, respectively, comparable to those in the NS group (2.36 years, (P = 0.18). Conclusions Breast surgery is associated with improved survival in stage IV breast cancer. However, in our experience, this benefit is only realized among patients operated on before diagnosis of metastatic disease and is likely a consequence of stage migration bias. While some women may warrant palliative surgery to the breast, it is unclear that such surgery otherwise improves clinical outcomes.
KeywordsStage IV breast cancer Surgery Survival Mastectomy
- 1.Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ et al (eds) (2007) SEER Cancer Statistics Review, 1975–2004, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site
- 4.Goldberg RM, Fleming TR, Tangen CM et al (1998) Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med 129:27PubMedGoogle Scholar
- 11.Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA (2007) Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol 14(8):2187–2194. doi: 10.1245/s10434-007-9438-0 PubMedCrossRefGoogle Scholar
- 12.Fields RC, Jeffe DB, Trinkaus K et al (2007) Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis. Ann Surg Oncol 14:3345–3351. doi: 10.1245/s10434-007-9527-0 PubMedCrossRefGoogle Scholar