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Role of breast surgery in T1-3 breast cancer patients with synchronous bone metastases

  • Epidemiology
  • Published:
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Abstract

The impact of breast surgery on survival of metastatic breast cancer (MBC) patients is controversial. We addressed the question in a mono-institutional series of MBC patients with synchronous bone metastases. We identified 187 consecutive women diagnosed between 2000 and 2008 with locally operable (T1–T3) MBC, synchronous bone metastases, with no other distant sites being involved. Progression-free survival (PFS) and overall survival (OS) were compared between operated and non-operated patients. Median age was 51 years; 92 % of the women had a hormone-positive tumor. At the time of diagnosis, 131 patients out of 187 (70 %) underwent surgery. Operated and non-operated patients differed in terms of number of bone metastatic sites: a single metastasis was detected in 35 (28 %) operated, and 6 (11 %) non-operated cases (P = 0.01). No other significant differences were observed. The multi-adjusted hazard ratio was 0.63 (95 % CI 0.43–0.92) for PFS and 0.64 (95 % CI 0.41–0.99) for OS in favor of surgery. The 5-year cumulative incidence of ipsilateral breast skin progressions among non-operated patients was 18 %. In this large and homogeneous series of MBC patients with synchronous bone metastases, the role of breast surgery had a favorable impact on both disease progression and mortality.

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References

  1. Sledge GW Jr, Cardoso F, Winer EP et al. (2012) A Dickens tale of the treatment of advanced breast cancer: the past, the present, and the future. Educational article presented at: American Society of Clinical Oncology Congress. Chicago, IL

  2. Erwin RL (2010) Therapy for advanced stage cancer: what do patients want and expect? A patient advocate’s perspective. Oncologist 15(Suppl 1):11–12

    Article  PubMed  Google Scholar 

  3. Cardoso F, Di LA, Lohrisch C, Bernard C et al (2002) Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol 13(2):197–207

    Article  PubMed  CAS  Google Scholar 

  4. Foukakis T, Fornander T, Lekberg T et al (2011) Age-specific trends of survival in metastatic breast cancer: 26 years longitudinal data from a population-based cancer registry in Stockholm, Sweden. Breast Cancer Res Treat 130(2):553–560

    Article  PubMed  Google Scholar 

  5. Dafni U, Grimani I, Xyrafas A et al (2010) Fifteen-year trends in metastatic breast cancer survival in Greece. Breast Cancer Res Treat 119(3):621–631

    Article  PubMed  CAS  Google Scholar 

  6. O’Shaughnessy J (2005) Extending survival with chemotherapy in metastatic breast cancer. Oncologist 10(Suppl 3):20–29

    Article  PubMed  Google Scholar 

  7. Blackwell KL, Burstein HJ, Storniolo AM et al (2012) Overall survival benefit with lapatinib in combination with trastuzumab for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: final results from the EGF104900 study. J Clin Oncol 30(21):2585–2592

    Article  PubMed  CAS  Google Scholar 

  8. Baselga J, Cortés J, Kim SB et al (2012) Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 366(2):109–119

    Article  PubMed  CAS  Google Scholar 

  9. Pagani O, Senkus E, Wood W et al (2010) International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst 102(7):456–463

    Article  PubMed  Google Scholar 

  10. Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132(4):620–626

    Article  PubMed  Google Scholar 

  11. Gnerlich J, Jeffe DB, Deshpande AD et al (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

    Article  PubMed  Google 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(12):3345–3351

    Article  PubMed  Google Scholar 

  13. Babiera GV, Rao R, Feng L et al (2006) Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol 13(6):776–782

    Article  PubMed  Google Scholar 

  14. Rapiti E, Verkooijen HM, Vlastos G et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24(18):2743–2749

    Article  PubMed  Google Scholar 

  15. Blanchard DK, Shetty PB, Hilsenbeck SG et al (2008) Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg 247(5):732–738

    Article  PubMed  Google Scholar 

  16. Hazard HW, Gorla SR, Scholtens D et al (2008) Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 113(8):2011–2019

    Article  PubMed  Google Scholar 

  17. Le Scodan R, Stevens D, Brain E et al (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27(9):1375–1381

    Article  PubMed  Google Scholar 

  18. Shien T, Kinoshita T, Shimizu C et al (2009) Primary tumor resection improves the survival of younger patients with metastatic breast cancer. Oncol Rep 21(3):827–832

    PubMed  Google Scholar 

  19. Bafford AC, Burstein HJ, Barkley CR et al (2009) Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat 115(1):7–12

    Article  PubMed  Google Scholar 

  20. Neuman HB, Morrogh M, Gonen M et al (2010) Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer 116(5):1226–1233

    Article  PubMed  Google Scholar 

  21. Pathy NB, Verkooijen HM, Taib NA et al (2011) Impact of breast surgery on survival in women presenting with metastatic breast cancer. Br J Surg 98(11):1566–1572

    Article  PubMed  Google Scholar 

  22. Ruiterkamp J, Ernst MF, van de Poll-Franse LV, Bosscha K, Tjan-Heijnen VC, Voogd AC (2009) Surgical resection of the primary tumor is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol 35(11):1146–1151

    Article  PubMed  CAS  Google Scholar 

  23. Perez-Fidalgo JA, Caballero A, Lluch A (2012) Integrating radical local treatment of the primary in the management of stage IV breast cancer. When is the best moment for the resection of the primary tumor? Eur J Surg Oncol 38(8):643–644

    Article  PubMed  CAS  Google Scholar 

  24. Rashaan ZM, Bastiaannet E, Portielje JE et al (2012) Surgery in metastatic breast cancer: patients with a favorable profile seem to have the most benefit from surgery. Eur J Surg Oncol 38(1):52–56

    Article  PubMed  CAS  Google Scholar 

  25. Cady B, Nathan NR, Michaelson JS et al (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15(12):3384–3395

    Article  PubMed  CAS  Google Scholar 

  26. Leung AM, Vu HN, Nguyen KA et al (2010) Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res 161(1):83–88

    Article  PubMed  Google Scholar 

  27. Dominici L, Najita J, Hughes M, Niland J, Marcom P, Wong YN, Carter B, Javid S, Edge S, Burstein H, Golshan M (2011) Surgery of the primary tumor does not improve survival in stage IV breast cancer. Breast Cancer Res Treat 129(2):459–465

    Article  PubMed  Google Scholar 

  28. Briasoulis E, Karavasilis V, Kostadima L, Ignatiadis M, Fountzilas G, Pavlidis N (2004) Metastatic breast carcinoma confined to bone: portrait of a clinical entity. Cancer 101(7):1524–1528

    Article  PubMed  Google Scholar 

  29. Mayer EL, Burstein HJ (2007) Chemotherapy for metastatic breast cancer. Hematol Oncol Clin North Am. 21(2):257–272

    Article  PubMed  Google Scholar 

  30. Petrelli F, Barni S (2012) Surgery of primary tumors in stage IV breast cancer: an updated meta-analysis of published studies with meta-regression. Med Oncol 29(5):3282–3290

    Article  PubMed  Google Scholar 

  31. Khan SA (2007) Does resection of an intact breast primary improve survival in metastatic breast cancer? Oncology 21(8):924–931

    PubMed  Google Scholar 

  32. Baum M, Demicheli R, Hrushesky W, Retsky M (2005) Does surgery unfavourably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases? Eur J Cancer 41(4):508–515

    Article  PubMed  Google Scholar 

  33. Sinha P, Clements VK, Miller S, Ostrand-Rosenberg S (2005) Tumor immunity: a balancing act between T cell activation, macrophage activation and tumor-induced immune suppression. Cancer Immunol Immunother 54(11):1137–1142

    Article  PubMed  CAS  Google Scholar 

  34. Nolé F, Munzone E, Zorzino L, Minchella I, Salvatici M, Botteri E, Medici M, Verri E, Adamoli L, Rotmensz N, Goldhirsch A, Sandri MT (2008) Variation of circulating tumor cell levels during treatment of metastatic breast cancer: prognostic and therapeutic implications. Ann Oncol 19(5):891

    Article  PubMed  Google Scholar 

  35. De Giorgi U, Valero V, Rohren E et al (2010) Circulating tumor cells and bone metastases as detected by FDG–PET/CT in patients with metastatic breast cancer. Ann Oncol 21:33–39

    Article  PubMed  Google Scholar 

  36. Kim MY, Oskarsson T, Acharyya S et al (2009) Tumor self-seeding by circulating cancer cells. Cell 139:1315–1326

    Article  PubMed  Google Scholar 

  37. Shien T, Nakamura K, Shibata T, Kinoshita T, Aogi K, Fujisawa T, Masuda N, Inoue K, Fukuda H, Iwata H (2012) A randomized controlled trial comparing primary tumour resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (PRIM-BC): Japan Clinical Oncology Group Study JCOG1017. Jpn J Clin Oncol 42(10):970–973

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Edoardo Botteri, Vincenzo Bagnardi, Nicole Rotmensz, Barbara Bazolli & Bruno Montanari

  2. Department of Occupational Health, University of Milan, Milan, Italy

    Edoardo Botteri

  3. Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy

    Elisabetta Munzone, Gaetano Aurilio, Angela Sciandivasci, Angela Esposito, Laura Adamoli, Franco Nolè & Aron Goldhirsch

  4. Division of Senology, European Institute of Oncology, Milan, Italy

    Mattia Intra & Gianmatteo Pagani

  5. Department of Statistics, University of Milan Bicocca, Milan, Italy

    Vincenzo Bagnardi

  6. Division of Pathology, European Institute of Oncology, Milan, Italy

    Giuseppe Viale

  7. University of Milan, Milan, Italy

    Giuseppe Viale

Authors
  1. Edoardo Botteri
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  2. Elisabetta Munzone
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  3. Mattia Intra
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  4. Vincenzo Bagnardi
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  6. Barbara Bazolli
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  7. Bruno Montanari
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  8. Gaetano Aurilio
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  9. Angela Sciandivasci
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  10. Angela Esposito
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  12. Laura Adamoli
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  13. Giuseppe Viale
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  14. Franco Nolè
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  15. Aron Goldhirsch
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Correspondence to Edoardo Botteri.

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Botteri, E., Munzone, E., Intra, M. et al. Role of breast surgery in T1-3 breast cancer patients with synchronous bone metastases. Breast Cancer Res Treat 138, 303–310 (2013). https://doi.org/10.1007/s10549-013-2449-6

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  • DOI: https://doi.org/10.1007/s10549-013-2449-6

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