Surgery and survival in patients with stage IV breast cancer

• Type of Material: Article
• Authors: Cletus Arciero, Emory University; Yuan Liu, Emory University; Theresa Gillespie, Emory University; Preeti Subhedar, Emory University
• Language: English
• Date: 2019-07-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/tbj.13296
• Title of Journal or Parent Work: The Breast Journal
• Volume: 25
• Issue: 4
• Start Page: 644
• End Page: 653
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: Resection; Primary tumor; Metaanalysis; Impact; Obstetrics & Gynecology; Intact primary; Women; Score; De-novo; Oncology; Therapy; Life Sciences & Biomedicine; Initial presentation; Science & Technology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology

Abstract

Background: Retrospective studies have shown some improvement in survival for patients receiving surgical management of the intact primary tumor in patients with presenting with Stage IV disease, while prospective studies have revealed mixed results. Methods: An examination of the NCDB from 2004–2013 was undertaken to examine factors related to the utilization of surgery and overall survival in patients with de novo Stage IV disease. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was implemented to balance patients’ baseline characteristics. Results: A total of 11,694 patients with Stage IV breast cancer at diagnosis met inclusion criteria. Surgical intervention occurred in 5,202 patients (44.5%), with the use of surgery decreasing throughout the study period (53.6% surgery 2004–2006; 31.8% surgery 2011–2013). Selection for surgical intervention was associated with small tumors (T1) and a higher nodal burden (N2/3). Uninsured patients, those treated at academic centers, those treated in the Northeast, and those with hormone receptor positive tumors were less likely to undergo surgery. Surgery was independently associated with a better overall survival. Propensity score matching revealed a persistent survival advantage for surgical patients receiving surgery, regardless of the receipt of systemic therapy. Conclusions: Surgery on the intact primary tumor for patients presenting with de novo Stage IV breast cancer is associated with improved overall survival. Surgical resection in patients with Stage IV breast cancer should be considered for well-selected patients as a part of multimodality therapy.