Survival benefit of a combined surgical approach in patients with metastatic breast cancer. Issue 8 (26th August 2021)

• Record Type: Journal Article
• Authors: Bilani, Nadeem; Yaghi, Marita; Singh Jabbal, Iktej; Elson, Leah; Elimimian, Elizabeth Blessing; Liang, Hong; Nahleh, Zeina
• Is Part Of: Journal of surgical oncology. Volume 124:Issue 8(2021)
• Page Start: 1235
• Page End: 1241
• Publication Date: 2021-08-26
• Subjects: breast neoplasms -- metastasectomy -- medical oncology -- mastectomy -- registries; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26656
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: We previously reported survival benefit of surgery in patients with stage IV breast cancer (BC); prospective trials yielded inconclusive results. Methods: We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metastasectomy. A multivariate Cox‐regression survival model investigated the overall survival (OS) of this surgical approach as compared to lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. The Kaplan–Meier method was used to demonstrate the utility of surgery when metastasis were confined to 1 site stratifying by tissue type. Results: A total of n = 55, 125 patients were included. As compared to lumpectomy/mastectomy alone (43 months), lumpectomy/mastectomy + metastasectomy exhibited the best OS (50 months, p = 0.012), metastasectomy alone showed slightly worse OS (30 months, p < 0.0001), and no surgery had the worst OS (21 months, p < 0.0001). In metastasis confined to 1 site, superior OS with combined lumpectomy/mastectomy and metastasectomy versus lumpectomy/mastectomy alone was observed with liver (72.8 vs. 48.1 months, p < 0.001) or lung (49.2 vs. 36.8 months, p < 0.001) metastasis but not bone (52.2 vs. 49.9 months, p < 0.001) or brain (16.2 vs. 15.5 months, p < 0.001). Conclusion: Patients with metastatic BC undergoing primary site resection and metastasectomy exhibited optimal OS, particularly when metastasis involved only the liver or lung.