Michael Co1, Judy Ng2, Ava Kwong3. 1. Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong. 2. Department of Surgery, Queen Mary Hospital, Hong Kong. 3. Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong. Electronic address: avakwong@hku.hk.
Abstract
BACKGROUND: Treatment of de novo metastatic breast cancer is usually palliative with systemic treatment; surgical excision of the primary tumour is reserved in patients with significant symptoms from the primary tumour. Survival benefit of surgical removal of the primary tumour remains controversial. METHODS: All patients treated with de novo metastatic breast cancer (MBC) between 2007 and 2016 were retrieved from a prospectively-maintained database. Demographic and tumour characteristics were compared. Overall survival (OS) was analysed using Kaplan-Meier Method and log rank tests. Multivariate analysis was performed to evaluate the prognosticators of OS in de novo MBC. RESULTS: Median age of diagnosis was 53 years old (Range 24-91 years old). 91 patients received resection of the primary tumour, including 86 mastectomies and 5 breast conserving surgeries (surgical group). 81 patients were never treated surgically (non-surgical group). Baseline demographic data were comparable apart from being younger age in the surgical group. 5-year OS in surgical group was significantly better than non-surgical group (43.9% vs. 33.9%, p = 0.026). Multivariate analysis found that advanced age (Hazard ratio: 1.034, p = 0.005, 95% CI 1.010-1.058) and presence of visceral metastasis (Hazard ratio: 1.672, p = 0.038, 95% CI 1.028-2.719) were significant adverse prognosticators through multivariate analysis; while positive oestrogen receptor (ER) status was the only positive prognosticator in the analysis (Hazard ratio: 0.42, p = 0.001, 95% CI 0.256-0.688). CONCLUSION: Surgical excision of primary breast tumour may confer survival benefit in de novo MBC.
BACKGROUND: Treatment of de novo metastatic breast cancer is usually palliative with systemic treatment; surgical excision of the primary tumour is reserved in patients with significant symptoms from the primary tumour. Survival benefit of surgical removal of the primary tumour remains controversial. METHODS: All patients treated with de novo metastatic breast cancer (MBC) between 2007 and 2016 were retrieved from a prospectively-maintained database. Demographic and tumour characteristics were compared. Overall survival (OS) was analysed using Kaplan-Meier Method and log rank tests. Multivariate analysis was performed to evaluate the prognosticators of OS in de novo MBC. RESULTS: Median age of diagnosis was 53 years old (Range 24-91 years old). 91 patients received resection of the primary tumour, including 86 mastectomies and 5 breast conserving surgeries (surgical group). 81 patients were never treated surgically (non-surgical group). Baseline demographic data were comparable apart from being younger age in the surgical group. 5-year OS in surgical group was significantly better than non-surgical group (43.9% vs. 33.9%, p = 0.026). Multivariate analysis found that advanced age (Hazard ratio: 1.034, p = 0.005, 95% CI 1.010-1.058) and presence of visceral metastasis (Hazard ratio: 1.672, p = 0.038, 95% CI 1.028-2.719) were significant adverse prognosticators through multivariate analysis; while positive oestrogen receptor (ER) status was the only positive prognosticator in the analysis (Hazard ratio: 0.42, p = 0.001, 95% CI 0.256-0.688). CONCLUSION: Surgical excision of primary breast tumour may confer survival benefit in de novo MBC.
Authors: Caitlin E Marks; Samantha M Thomas; Oluwadamilola M Fayanju; Gayle DiLalla; Sarah Sammons; E Shelley Hwang; Jennifer K Plichta Journal: Am J Surg Date: 2021-07-22 Impact factor: 2.565