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Clinical Evidence for Locoregional Surgery of the Primary Tumor in Patients with De Novo Stage IV Breast Cancer

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

Abstract

Background

Whether primary tumor surgery is better than no surgery in patients with de novo stage IV breast cancer remains controversial.

Methods

This study combined prospective clinical trials and a multicenter cohort to evaluate the impact of locoregional surgery in de novo stage IV breast cancer. The GRADE approach was used to assess the quality of evidence in meta-analysis, and propensity score matching analysis was used in the cohort study. This study was registered with PROSPERO CRD42016043766 and ClinicalTrials.gov NCT04456855.

Results

A total of 1110 patients from six trials and 353 patients from the cohort study were included. The meta-analysis showed that compared with no surgery, locoregional surgery did not prolong overall survival (hazard ratio [HR] = 0.90, P = 0.40; moderate-quality) but had a significantly longer locoregional progression-free survival (HR = 0.23, P < 0.001; moderate-quality). The subgroup analysis of solitary bone-only metastasis (HR = 0.47, P = 0.04; high-quality) resulted in prolonged overall survival. In the cohort study, locoregional surgery showed a survival benefit (HR = 0.63, P = 0.041) before matching, but not (HR = 0.84, P = 0.579) after matching. Patients with bone-only metastasis showed a survival advantage in surgery compared with no surgery before matching (HR = 0.36, P = 0.034) as well as after matching (HR = 0.18, P = 0.017).

Conclusions

This study indicated that locoregional surgery had a significantly longer locoregional progression-free survival than no surgery in de novo stage IV breast cancer, and patients with bone-only metastasis tended to show an overall survival benefit from surgery.

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Acknowledgment

The authors thank the patients who participated in this study and all investigators contributed to these trials.

Funding

This study was supported by Grant 2020ZX09201021 from the National Science and Technology Major Project, Grant YXRGZN201902 from the Medical Artificial Intelligence Project of Sun Yat-Sen Memorial Hospital, Grants 81572596, 81972471, U1601223, 82073408, 81802656, and 82071754 from the National Natural Science Foundation of China, Grant 2017A030313828 from the Natural Science Foundation of Guangdong Province, Grant 201704020131 from the Guangzhou Science and Technology Major Program, Grant 2017B030314026 from the Guangdong Science and Technology Department, Grant 2018007 from the Sun Yat-Sen University Clinical Research 5010 Program, grant SYS-C-201801 from the Sun Yat-Sen Clinical Research Cultivating Program.

Author information

Author notes

  1. Yunfang Yu, Huangming Hong, and Ying Wang have contributed equally and should be considered co-first authors.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Yunfang Yu MD, Huangming Hong MD, Ying Wang MD, Jianli Zhao MD, Yujie Tan MD, Zifan He MD, Wei Ren MD & Herui Yao MD

  2. Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

    Tuping Fu MD, Ruizhao Cai MD, Lihuan Zhou MD, Junhao Huang MD & Jun Tang MD

  3. Department of Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Yongjian Chen MD

  4. Department of Breast Surgery, The First People’s Hospital of Foshan, Fosan Afflicted Hospital of Sun Yat-sen University, Foshan, China

    Peixian Chen MD & Guolin Ye MD

Authors
  1. Yunfang Yu MD
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Contributions

Dr Yunfang Yu, Ruizhao Cai, Peixian Chen, and Prof Jun Tang, Guolin Ye, and Herui Yao had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Jun Tang MD, Guolin Ye MD or Herui Yao MD.

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Disclosures

The authors declare that they have no conflict of interest.

Administrative, Technical, or Material Support

Yunfang Yu, Huangming Hong, Ying Wang, Yongjian Chen, Yujie Tan, Jun Tang, Guolin Ye, and Herui Yao

Acquisition, Analysis, or Interpretation of Data

All authors.

Critical Revision of the Manuscript for Important Intellectual Content

All authors.

Concept and Design

Yunfang Yu, Huangming Hong, Ying Wang, Jun Tang, Guolin Ye, and Herui Yao.

Drafting of the Manuscript

Yunfang Yu, Huangming Hong, Ying Wang, Yujie Tan, Tuping Fu, Yongjian Chen, Jun Tang, Guolin Ye, and Herui Yao.

Obtained Funding

Herui Yao.

Statistical Analysis

All authors.

Supervision

Jun Tang, Guolin Ye, and Herui Yao.

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Yu, Y., Hong, H., Wang, Y. et al. Clinical Evidence for Locoregional Surgery of the Primary Tumor in Patients with De Novo Stage IV Breast Cancer. Ann Surg Oncol 28, 5059–5070 (2021). https://doi.org/10.1245/s10434-021-09650-3

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  • DOI: https://doi.org/10.1245/s10434-021-09650-3

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