Elsevier

Surgery

Volume 132, Issue 4, October 2002, Pages 620-627
Surgery

Central Surgical Association
Does aggressive local therapy improve survival in metastatic breast cancer?*

Presented at the 59th Annual Meeting of the Central Surgical Association, Pittsburgh, Pa, March 7-9, 2002.
https://doi.org/10.1067/msy.2002.127544Get rights and content

Abstract

Background. Women with metastatic breast cancer and an intact primary tumor are currently treated with systemic therapy. Local therapy of the primary tumor is considered irrelevant to the outcome, and is recommended only for palliation of symptoms. Methods. We have examined the use of local therapy, and its impact on survival in patients presenting with stage IV breast cancer at initial diagnosis, who were reported to the National Cancer Data Base (NCDB) between 1990 and 1993. Results. A total of 16,023 patients with stage IV disease were identified in the NCDB during this period, of whom 6861 (42.8%) received either no operation or a variety of diagnostic or palliative procedures, and 9162 (57.2%) underwent partial (3513) or total (5649) mastectomy. The presence of free surgical margins was associated with an improvement in 3-year survival in partial or total mastectomy groups (26% vs 35%, respectively). A multivariate proportional hazards model identified the number of metastatic sites, the type of metastatic burden, and the extent of resection of the primary tumor as significant independent prognostic covariates. Women treated with surgical resection with free margins, when compared with those not surgically treated, had superior prognosis, with a hazard ratio of 0.61 (95% confidence interval 0.58,0.65). Conclusions. These data suggest that the role of local therapy in women with stage IV breast cancer needs to be re-evaluated, and local therapy plus systemic therapy should be compared with systemic therapy alone in a randomized trial. Surgery 2002;132:620-7.

Section snippets

Methods

The NCDB is a joint project of the Commission on Cancer of the ACS and the American Cancer Society, whose goal is to lower the morbidity and mortality of cancer by providing information about cancer management and outcomes. The NCDB collects data annually on all forms of cancer throughout the country from computerized hospital cancer registries.2, 3 Eleven NCDB calls for data have been issued since 1989 and have yielded in excess of 11 million incident cancer cases from more than 1900 hospital

Results

Women who presented with stage IV breast cancer comprised 4.1% of the total number of breast cancer cases accrued to the NCDB during a 4-year period from 1990 to 1993 (a cohort for which the most recent mature follow up data are available). Their mean age was 62.5 years, and 50% of the study population was between 60 and 79 years of age. Of 16,023 women who met the selection criteria 6861 (42.8%) received no surgical resection of the primary tumor. Some of these patients were reported as

Discussion

In this study, on the basis of a retrospective review of data from the NCDB, we find that the use of PM or TM in women presenting with metastatic breast cancer affords an independent, statistically significant survival advantage, with a reduction in the hazard of death from 1.0 in the no operation group, to 0.88 in women undergoing PM, and to 0.74 in those undergoing TM. Univariate analysis shows this benefit increases steadily between women who have no surgical procedure (3-year survival,

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*

Reprint requests: Seema A. Khan, MD, Department of Surgery, Northwestern University Medical School, 201 E Huron St, Suite 10-105, Chicago, IL 60611.

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