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Surgery of the primary tumor in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium

  • Epidemiology
  • Published:
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A Correction to this article was published on 09 April 2024

This article has been updated

Abstract

Purpose

We aimed to assess the impact of surgery of primary tumor in overall survival (OS) of women with de novo metastatic breast cancer.

Methods

Nationwide, population-based retrospective cohort study of women diagnosed with de novo metastatic breast cancer in Belgium, between Jan/2010-Dec/2014. Data was obtained from the Belgian Cancer Registry and administrative databases. “Surgery” group was defined by surgery of primary tumor up to nine months after diagnosis. We excluded women who did not receive systemic treatment or did not complete nine months follow-up after diagnosis. All the subsequent analyses reporting on overall survival and the stratified outcome analyses were performed based on this nine-month landmark cohort. OS was estimated using Kaplan-Meier method and compared using adjusted Cox proportional hazards models controlling for confounders with 95% confidence intervals (CI). We performed a stratified analysis according to surgery timing and a propensity score matching analysis.

Results

1985 patients, 534 (26.9%) in the “Surgery” and 1451 (73.1%) in the “No Surgery” group. Patients undergoing surgery were younger (p < 0.001), had better performance status (PS) (p < 0.001), and higher proportion of HER2-positive and triple-negative breast cancer (p = 0.012). Median follow-up was 86.0 months (82.6–88.5). Median OS was 60.1 months (57.1–68.2) in the “Surgery” vs. 41.9 months (39.8–44.2) in the “No Surgery” group (adjusted HR 0.56; 0.49–0.64). OS was similar when surgery was performed upfront or after systemic treatment. Propensity score matching analysis confirmed the same findings.

Conclusion

Among patients receiving systemic treatment for de novo metastatic breast cancer and surviving nine months or more, those who received surgery of the primary tumor within nine months of diagnosis have longer subsequent survival than those who did not.

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Data Availability

The data that support the findings of this study are available from the Belgian Cancer Registry but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Belgian Cancer Registry.

Change history

Abbreviations

CI:

Confidence interval

HER2:

Human Epidermal growth factor Receptor type 2

HR:

Hazard ratio

ER:

Estrogen receptor

ECOG:

Eastern Cooperative Oncology Group

OS:

Overall survival

PS:

Performance status

TNBC:

Triple-negative breast cancer

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Acknowledgements

We thank the Belgian Cancer Registry for the support provided and for the prior data collection of the immunohistochemistry subtypes for the women diagnosed with breast cancer in the year of 2014 included in this analysis [51].

Funding

Belgian Society of Medical Oncology (BSMO) supported the costs of access to Belgian Cancer Registry infrastructure, data coupling and training provided. The Fonds Pink Ribbon provided financial support for the manual retrieval of information from the pathology reports at the Belgian Cancer Registry.

Author information

Author notes

  1. Mariana Brandão and Diogo Martins-Branco have contributed equally to this work

Authors and Affiliations

  1. Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium

    Mariana Brandão, Diogo Martins-Branco, Claudia De Angelis & Evandro de Azambuja

  2. Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium

    Mariana Brandão, Ahmad Awada, Martine Piccart-Gebhart & Evandro de Azambuja

  3. Clinical Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

    Claudia De Angelis

  4. CHU UCL Namur, Site Ste Elisabeth, UC Louvain, Namur, Belgium

    Peter Vuylsteke

  5. Department of Internal Medicine, University of Botswana, Gaborone, Botswana

    Peter Vuylsteke

  6. Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, United States of America

    Richard D. Gelber

  7. Belgian Cancer Registry, Brussels, Belgium

    Nancy Van Damme & Lien van Walle

  8. Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal

    Arlindo R. Ferreira

  9. Católica Medical School, Universidade Católica Portuguesa, Rio de Mouro, Portugal

    Arlindo R. Ferreira

  10. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy

    Matteo Lambertini

  11. Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Matteo Lambertini

  12. Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Francesca Poggio

  13. Medical Oncology, AZ Klina, University of Antwerp, Antwerp, Belgium

    Didier Verhoeven

  14. Medical Oncology, CHR Verviers East Belgium, Verviers, Belgium

    Annelore Barbeaux

  15. Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Francois P. Duhoux

  16. Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium

    Hans Wildiers & Kevin Punie

  17. Breast International Group, Brussels, Belgium

    Carmela Caballero

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  1. Mariana Brandão
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  2. Diogo Martins-Branco
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Contributions

Conception/design: MB, CDA, NVD, EA. Provision of study material or patients: NVD, LvW. Collection and/or assembly of data: NVD, LvW. Data analysis and interpretation: MB, DMB, CDA, RDG, EA. Manuscript writing: MB, DMB. Final approval of manuscript: all authors.

Corresponding author

Correspondence to Evandro de Azambuja.

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Competing Interests

Research grants to Institut Jules Bordet (MB, DMB, CDA, AA, MP, EdA): from Roche/GNE, Radius, AstraZeneca, Lilly, MSD, GSJ/Novartis, Synthon, Servier, and Pfizer (all outside the submitted work). MB: travel grant from Roche, Takeda and Sanofi; speaker honoraria from Roche, Takeda and Janssen; advisory board from Sanofi (all outside the submitted work). DMB: honoraria from Daiichi Sankyo, Novartis, Merck Sharp & Dohme, Janssen, Pfizer, and Angelini; Meeting/travel grants from Novartis, Merck Sharp & Dohme, LEO Farmacêuticos, Ipsen, Janssen; (all outside the submitted work). PV: travel, speakers and advisory fees via Roche, MSD, BMS, Pfizer, Novartis, Lilly. ARF: honoraria and/or advisory board fees from Daiichi Sankyo, Gilead, Merck Sharp & Dohme, Novartis, Roche; meeting/travel grants: Roche (all outside the submitted work). ML: consultancy for Roche, Lilly, AstraZeneca, Pfizer, Novartis, MSD, Seagen, Exact Sciences, Gilead; speaker honoraria from Roche, Takeda, Ipsen, Sandoz, Knight, Libbs, Lilly, Pfizer, Novartis, Daiichi Sankyo, Gilead; travel grant from Gilead; institutional research grant from Gilead. FP: support for attending meetings from Daichii Sankyo and Gilead; participation on advisory board from AstraZeneca; and fees or honoraria from Eli Lilly and Novartis (all outside the submitted work). FPD: advisory role (support to Institution) for Amgen, AstraZeneca, Daiichi Sankyo, Eli Lilly, Gilead, Mundipharma, Novartis, Pfizer, Pierre Fabre, Roche, Seagen, and Teva. HW: his institution received financial compensation on his behalf for advisory boards, lecture fees and/or consultancy fees from Immutep Pty, MSD, Astrazenca, Daiichi, AbbVie, Lilly, Roche, EISAI, Pfizer, Sirtex, Gilead; travel grant from Pfizer and Roche. CC: employment at Breast International Group; institution research grant from AstraZeneca, Roche/Genentech, Tesaro, Novartis, Pfizer, SERVIER, Biovica, GlaxoSmithKline, and Sanofi/Aventis; institutional royalties from Agendia for MammaPrint; board member of European Society of Surgical Oncology (all outside of submitted work). AA: advisory role, research grants to my Institute, speaker fees: Roche, Lilly, Amgen, EISAI, BMS, Pfizer, Novartis, MSD, Genomic Health, Ipsen, AstraZeneca, Bayer, Leo Pharma. MPG: consultancy for AstraZeneca, Lilly, MSD, Novartis, Odonate, Pfizer, Roche, Camel-IDS, Crescendo Biologics, Periphagen, Huya, Debiopharm, PharmaMar, G1 Therapeutics, Menarini, Seattle Genetics, Immunomedics, and Oncoloytics; board member of Radius. KP: research grants to institute from MSD and Sanofi; speaker fees and honoraria for consultancy and advisory board functions from Astra Zeneca, Eli Lilly, Exact Sciences, Focus Patient, Gilead, MSD, Novartis, Pfizer, Roche, and Seagen; speaker fees and honoraria for consultancy and advisory board functions to institution from Astra Zeneca, Eli Lilly, Exact Sciences, Gilead, MSD, Novartis, Pfizer, Roche, and Seagen; stock options from Need Inc; travel grants from Astra Zeneca, Novartis, Pfizer, PharmaMar, and Roche. EdA: Honoraria and advisory board from Roche/GNE, Novartis and SeaGen. Travel grants from Roche/GNE and GSK/Novartis. Other authors: no conflicts of interest.

Ethics approval

Approval of the Ethical committee was not necessary based on the fact that this retrospective study does not fall under the Belgian Law of 7 May 2004 regarding experiments on human persons (art. 3,§ 2).

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Brandão, M., Martins-Branco, D., De Angelis, C. et al. Surgery of the primary tumor in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium. Breast Cancer Res Treat 203, 351–363 (2024). https://doi.org/10.1007/s10549-023-07116-6

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