Abstract
Women with Metastatic Breast Cancer (MBC) and an intact primary have long been treated with systemic therapy alone. Local therapy is not considered unless for palliative reasons. However, several studies have suggested local treatment in the form of Surgery for the primary improves overall survival in certain groups of MBC patients. We evaluated the factors influencing the outcome in this group of patients. In a retrospective review of our prospective database, we identified the patients who presented with MBC and underwent surgery for primary tumour (2004–2009). Patients' surgical details and clinicopathological factors were reviewed. The overall survival of the MBC patients who underwent surgery was evaluated and compared depending on the various clinicopathological factors. Out of 196 patients with MBC, 48 underwent surgery of the primary tumor during their treatment course. Median overall survival was better in patients with young age (<=40 years), Estrogen receptor(ER) positive tumors (31.4 months vs 21.2 months), single metastatic site vs multiple metastatic sites (43.4 months vs 26.69 months). We also found that patients with low level of suspicion for metastases fared better than those with high level of suspicion (43.4 months vs 20.9 months). Our data analysis suggested that for MBC patients who undergo surgery, survival is significantly worse in patients with pathological T4 lesions and there is a trend towards better survival in younger patients and in those who have ER positive tumour, Her2neu negative tumour, single site of metastases and patients with low level of metastatic suspicion. However these factors need to be evaluated in a randomized trial comparing with patients who have not undergone surgery.
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References
Khan S, Stewart A, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132:620–627
Danna EA, Sinha P, Gilbert M et al (2004) Surgical removal of primary tumor reverses tumor-induced immunosuppression despite the presence of metastatic disease. Cancer Res 64:2205–2211
Weigelt B, Peterse JL, Van’t Veer LJ (2005) Breast cancer metastasis: markers and models. Nat Rev Cancer 5(8):591–602
Schmidt-Kittler O, Ragg T, Daskalakis A et al (2003) From latent disseminated cells to overt metastasis: genetic analysis of systemic breast cancer progression. Proc Natl Acad Sci U S A 100(13):7737–7742
Lang JE, Babiera GV (2007) Locoregional Resection in Stage IV Breast Cancer: Tumor Biology, Molecular and Clinical Perspectives. Surg Clin N Am 87:527–538
Braun S, Vogl FD, Naume B et al (2005) A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med 353(8):793–802
Carmichael AR, Anderson ED, Chetty U et al (2003) Does local surgery have a role in the management of Stage IV breast cancer? Eur J Surg Oncol 29(1):17–19
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 24:2743–2749
Babiera GV 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 13:776–782
Gnerlich J, Jeffe D, Deshpane A 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 14:2187–2194
Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM (2008) Association of Surgery With Improved Survival in Stage IV Breast Cancer Patients. Ann Surg 247:732–738
Cady B, Nathan NR, Michaelson JS, Golshan M, Smith BL (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15:3384–3395
Shien T, Kinoshita T, Shimizu C et al (2009) Primary tumor resection improves the survival of younger patients with metastatic breast cancer. Oncol Rep 21:827–832
McGuire KP, Eisen S, Meade T, Cox CE, Khakpour N, Rodriguez (2009) Factors associated with improved outcome after surgery in metastatic breast cancer patients. Am J Surg 198:511–515
Ruiterkamp J, Ernst MF, van de Poll-Franse LV, Bosscha K, Tjan-Heijnen VC, Voogd AC (2009) Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol 35:1146–1151
Bafford AC, Burstein HJ, Barkley CR, Smith BL, Lipsitz S, Iglehart JD, Winer EP, Golshan M (2009) Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat 115:7–12
Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD (2009) Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res. doi:10.1016/j.jss.2008.12.030
Vohra L, Khan S, Khan N (2011) Does primary tumour excision affect survival in metastatic breast cancer? Breast 20(Supplement 1), Abstract number P318
Rao R, Feng L, Kuerer H et al (2008) Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Ann Surg Oncol 6:1696–1702
Holmes FA, Buzdar AU, Kau SW et al (1994) Combined-modality approach for patients with isolated recurrences of breast cancer (IV-NED): The MD Anderson experience. Breast Dis 7:7–20
Nieto Y, Nawaz S, Jones RB et al (2002) Prognostic model for relapse after high-dose chemotherapy with autologous stem-cell transplantation for stage IV oligometastatic breast cancer. J Clin Oncol 20:707–718
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Khadakban, D., Gorasia-Khadakban, T., Vijaykumar, D.K. et al. Factors associated with better survival after surgery in metastatic breast cancer patients. Indian J Surg Oncol 4, 52–58 (2013). https://doi.org/10.1007/s13193-012-0204-9
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DOI: https://doi.org/10.1007/s13193-012-0204-9