Caitlin E Marks1, Samantha M Thomas2, Oluwadamilola M Fayanju3, Gayle DiLalla4, Sarah Sammons5, E Shelley Hwang6, Jennifer K Plichta7. 1. Duke University Medical Center, Department of Surgery, Durham, NC, USA. 2. Duke Cancer Institute, Durham, NC, USA; Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA; Duke University, Department of Biostatistics & Bioinformatics, Durham, NC, USA. 3. Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Population Health Sciences, Durham, NC, USA; Durham VA Medical Center, Department of Surgery, Durham, NC, USA. 4. Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Women's Cancer Care Raleigh, Raleigh, NC, USA. 5. Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Medicine, Durham, NC, USA. 6. Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA. 7. Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Population Health Sciences, Durham, NC, USA. Electronic address: jennifer.plichta@duke.edu.
Abstract
BACKGROUND: We sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection. METHODS: Recursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models. RESULTS: All patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p < 0.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups. CONCLUSION: Prognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.
BACKGROUND: We sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection. METHODS: Recursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models. RESULTS: All patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p < 0.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups. CONCLUSION: Prognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.
Authors: Katherine Mallin; Bryan E Palis; Nancy Watroba; Andrew K Stewart; Daniel Walczak; Joseph Singer; John Barron; Wendy Blumenthal; Georgette Haydu; Stephen B Edge Journal: J Am Coll Surg Date: 2013-01-26 Impact factor: 6.113
Authors: Julie E Lang; Welela Tereffe; Melissa P Mitchell; Roshni Rao; Lei Feng; Funda Meric-Bernstam; Isabelle Bedrosian; Henry M Kuerer; Kelly K Hunt; Gabriel N Hortobagyi; Gildy V Babiera Journal: Ann Surg Oncol Date: 2013-01-11 Impact factor: 5.344