Kang Wang1, Yang Shi2, Zhu-Yue Li3, Ye-Lei Xiao4, Jie Li4, Xiang Zhang5, Hong-Yuan Li6. 1. Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China. Electronic address: kang_wang0822@hotmail.com. 2. Division of Biostatistics and Data Science, Department of Population Health Science, Medical College of Georgia, Augusta University, Augusta, GA, USA. Electronic address: yshi@augusta.edu. 3. West China Hospital / West China School of Nursing, Sichuan University, Chengdu, China; Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China. 4. Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China. 5. Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China. Electronic address: cq_zhangxiang@163.com. 6. Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China. Electronic address: hongy_li@hotmail.com.
Abstract
INTRODUCTION: Role of surgery in the management of de novo stage IV breast cancer (BC) remains controversial. We aimed to determine the survival benefit of primary surgery on the basis of metastatic pattern. MATERIALS AND METHODS: A retrospective cohort study based on the SEER database was conducted to identify patients with de novo stage IV BC diagnosed between 2010 and 2015. Patients were divided into surgery and non-surgery group, and propensity score weighting was used to balance clinicopathologic factors between groups. RESULTS: Of 8142 de novo stage IV BC patients, 1891 (23%) cases were managed with surgery and 6251 (77%) cases were managed without surgery. There were 3821 all-cause deaths and 3291 BC specific deaths over a median follow-up of 22 months. The weighted 3-year overall survival (OS) for the surgery group was 54.5%, compared to 47.7% (P < 0.001) for the non-surgery group. The magnitude of the survival difference with surgery was significantly correlated with metastatic patterns (Pinteraction<0.05). Significant survival improvements in surgery group compared with non-surgery group were observed in patients with bone-only metastasis (adjusted HR = 0.83, P < 0.05) or multiple metastases with bone involved (adjusted HR = 0.76, P < 0.05), whereas survival inferiority of surgery was found for patients with multiple visceral organs-only metastases (adjusted HR = 2.08, P < 0.05). CONCLUSION: The survival benefit offered by surgery for de novo stage IV BC varies by metastatic patterns. Decisions for primary surgery of de novo stage IV BC patients should be tailored according to metastatic pattern.
INTRODUCTION: Role of surgery in the management of de novo stage IV breast cancer (BC) remains controversial. We aimed to determine the survival benefit of primary surgery on the basis of metastatic pattern. MATERIALS AND METHODS: A retrospective cohort study based on the SEER database was conducted to identify patients with de novo stage IV BC diagnosed between 2010 and 2015. Patients were divided into surgery and non-surgery group, and propensity score weighting was used to balance clinicopathologic factors between groups. RESULTS: Of 8142 de novo stage IV BC patients, 1891 (23%) cases were managed with surgery and 6251 (77%) cases were managed without surgery. There were 3821 all-cause deaths and 3291 BC specific deaths over a median follow-up of 22 months. The weighted 3-year overall survival (OS) for the surgery group was 54.5%, compared to 47.7% (P < 0.001) for the non-surgery group. The magnitude of the survival difference with surgery was significantly correlated with metastatic patterns (Pinteraction<0.05). Significant survival improvements in surgery group compared with non-surgery group were observed in patients with bone-only metastasis (adjusted HR = 0.83, P < 0.05) or multiple metastases with bone involved (adjusted HR = 0.76, P < 0.05), whereas survival inferiority of surgery was found for patients with multiple visceral organs-only metastases (adjusted HR = 2.08, P < 0.05). CONCLUSION: The survival benefit offered by surgery for de novo stage IV BC varies by metastatic patterns. Decisions for primary surgery of de novo stage IV BC patients should be tailored according to metastatic pattern.
Authors: Yumei Zhao; Guijun Xu; Xinpeng Guo; Wenjuan Ma; Yao Xu; Karl Peltzer; Vladimir P Chekhonin; Vladimir P Baklaushev; Nan Hu; Xin Wang; Zheng Liu; Chao Zhang Journal: Med Sci Monit Date: 2020-08-11