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The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy.

Methods

We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery.

Results

Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03–1.81) or private insurance (OR 1.93, 95% CI 1.53–2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76–2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47–2.70), and endocrine therapy (OR 1.73, 95% CI 1.40–2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53–0.87) were less likely to have surgery. Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p < 0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40–0.77).

Conclusions

Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society and the data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data.

Disclosures

The authors have no disclosures. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Ross Mudgway B.S., Carlos Chavez de Paz Villanueva M.D., M.P.H., Ann C. Lin M.D., Maheswari Senthil M.D., Carlos A. Garberoglio M.D. & Sharon S. Lum M.D., F.A.C.S.

  2. School of Medicine, University of California, Riverside, Riverside, CA, USA

    Ross Mudgway B.S. & Sharon S. Lum M.D., F.A.C.S.

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Mudgway, R., Chavez de Paz Villanueva, C., Lin, A.C. et al. The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy. Ann Surg Oncol 27, 2711–2720 (2020). https://doi.org/10.1245/s10434-020-08310-2

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