Could local surgery improve survival in de novo stage IV breast cancer?

Xiong, Zhenchong; Deng, Guangzheng; Wang, Jin; Li, Xing; Xie, Xinhua; Shuang, Zeyu; Wang, Xi

doi:10.1186/s12885-018-4767-x

Cited by 23 publications

(21 citation statements)

References 37 publications

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“…In previous studies, it was reported that negative margins, bone-only metastasis and systemic therapy were the favorable independent factors for survival, while positive margins, overexpression of HER2/neu and visceral metastasis were the adverse prognostic factors. 7,19,20 In this study, patients with ER and PR positive tumors had better prognosis. ER and PR status were independent prognostic factors, suggesting that tumor biology plays an important role in overall survival.…”

Section: Discussionmentioning

confidence: 53%

“…5,6 However, recent retrospective clinical studies have shown a positive impact on local control and overall survival in newly diagnosed stage IV breast cancer patients after primary site tumor resection. [7][8][9] Conversely, some studies have shown that surgery for metastatic breast cancer does not translate into survival benefits. 10,11 However, these retrospective studies were influenced by the selection bias, because they mainly included younger patients or with single metastatic lesion, only the bone or soft tissue metastasis.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Primary Site Surgery on Survival of Patients with de novo Stage IV Breast Cancer

Huang¹,

Tan²,

Qin³

et al. 2021

CMAR

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Impact of Primary Site Surgery on Survival of Patients with de novo Stage IV Breast Cancer

Huang¹,

Tan²,

Qin³

et al. 2021

CMAR

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“…A recently published multicentric retrospective study in France indicated that locoregional treatment improved overall survival in breast cancer patients with synchronous metastasis, especially in patients with the molecular subtype of HR-positive/HER2-negative and HER2positive (27). Another retrospective study in Chinese patients showed that surgical removal of the primary tumor could improve the prognosis of patients with bone metastasis alone (28). Importantly, surgery can offer solid pathological evidence for molecular classification, can alleviate clinical symptoms and can reduce tumor burden.…”

Section: Discussionmentioning

confidence: 99%

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

Wang

Sun

et al. 2020

Front. Oncol.

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Background and Aims: This research aimed to construct a novel model for predicting overall survival (OS) and surgical benefit in triple-negative breast cancer (TNBC) patients with de novo distant metastasis.Methods: We collected data from the Surveillance, Epidemiology, and End Results (SEER) database for TNBC patients with distant metastasis between 2010 and 2016. Patients were excluded if the data regarding metastatic status, follow-up time, or clinicopathological information were incomplete. Univariate and multivariate analyses were applied to identify significant prognostic parameters. By integrating these variables, a predictive nomogram and risk stratification model were constructed and assessed with C-indexes and calibration curves.Results: A total of 1,737 patients were finally identified. Patients enrolled from 2010 to 2014 were randomly assigned to two cohorts, 918 patients in the training cohort and 306 patients in the validation cohort I, and 513 patients enrolled from 2015 to 2016 were assigned to validation cohort II. Seven clinicopathological factors were included as prognostic variables in the nomogram: age, marital status, T stage, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The C-indexes were 0.72 [95% confidence interval [CI] 0.68-0.76] in the training cohort, 0.71 (95% CI 0.68-0.74) in validation cohort I and 0.71 (95% CI 0.67-0.75) in validation cohort II. Calibration plots indicated that the nomogram-based predictive outcome had good consistency with the recoded prognosis. A risk stratification model was further generated to accurately differentiate patients into three prognostic groups. In all cohorts, the median overall survival time in the low-, intermediate-and high-risk groups was 17.0 months (95% CI 15.6-18.4), 11.0 months (95% CI 10.0-12.0), and 6.0 months (95% CI 4.7-7.3), respectively. Locoregional surgery improved prognosis in both the low-risk [hazard ratio [HR] 0.49, 95% CI 0.41-0.60, P < 0.0001] and intermediate-risk groups (HR 0.55, 95% CI 0.46-0.67, P < 0.0001), but not in high-risk group (HR 0.73, 95% CI 0.52-1.03, P = 0.068). All stratified groups could prognostically benefit from chemotherapy (low-risk group: HR 0.50, 95% CI 0.35-0.69, P < 0.0001; intermediate-risk group: HR 0.34, Wang et al.Predictive Model for Metastatic TNBC 95% CI 0.26-0.44, P < 0.0001; and high-risk group: HR 0.16, 95% CI 0.10-0.25, P < 0.0001). Conclusion:A predictive nomogram and risk stratification model were constructed to assess prognosis in TNBC patients with de novo distant metastasis; these methods may provide additional introspection, integration and improvement for therapeutic decisions and further studies.

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“…The role of surgery in survival is consistent with the conclusions of previous studies. 7,[14][15][16][17] Furthermore, patients with only one symptom had better OS than those with more than one symptom (p = 0.0175). Considering all above results, we can boldly speculate that de novo stage IV BC patients who received surgery are less likely to occur LPRS.…”

Section: Discussionmentioning

confidence: 97%

Primary Tumor Surgery for Patients with De Novo Stage IV Breast Cancer can Decrease Local Symptoms and Improve Quality of Life

Yuan

et al. 2020

Ann Surg Oncol

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Background. It was unknown whether surgery for primary tumor would affect the occurrence of local symptoms caused by tumor progression in patients with de novo stage IV breast cancer (BC). Our work attempted to probe the effect of local resection on controlling local symptoms and improving the quality of life in de novo stage IV BC patients. Methods. Our study included patients presenting with de novo stage IV BC at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2008 to December 2014. In this study, we defined a new term called ''local progress/recurrence of symptoms'' (LPRS) to refer to the local problems caused by tumor progression/ recurrence. All the patients were grouped into surgery and non-surgery groups. The characteristics of the two groups were analyzed by Chi square and Fisher's test. Univariate and multivariate Cox regression models were designed to evaluate independent prognostic factors. Results. This study contained 177 patients. The follow-up deadline was April 1, 2019. The median follow-up time was 33 months (range 1-135 months). In included patients, 77 (43.5%) underwent surgery for primary tumors. Primary tumor surgery could reduce the occurrence of LPRS (relative risk/risk ratio (RR = 0.440; 95% CI 0.227-0.852; p = 0.015)) and patients without LPRS had longer OS (45 months vs 29 months, p \ 0.001). In addition, patients who had only one symptom had better OS than those who had two or three symptoms (p = 0.0175). Conclusions. The quality of life in patients with de novo stage IV breast cancer can be improved by reducing the incidence of local symptoms through primary tumor surgery. Keywords De novo stage IV breast cancer Á Local symptoms Á Primary tumor surgery Á Quality of life Á Survival Abbreviations BC Breast cancer LPRS Progress/recurrence symptoms OS Overall survival LPFS Local progression-free survival AJCC American Joint Committee on Cancer CR Complete response PR Partial response Generally, 3-5% of breast cancer (BC) patients in China are initially diagnosed as de novo stage IV BC. 1 The standard therapeutic approach was systemic therapy, especially chemotherapy. 2 Along with improvement of systemic treatment, which had prominently prolonged survival of patients, the effect of primary tumor surgery on de novo stage IV BC has gradually become a hot topic. 3

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Could local surgery improve survival in de novo stage IV breast cancer?

Cited by 23 publications

References 37 publications

Impact of Primary Site Surgery on Survival of Patients with de novo Stage IV Breast Cancer

Impact of Primary Site Surgery on Survival of Patients with de novo Stage IV Breast Cancer

A Risk Stratification Model for Predicting Overall Survival and Surgical Benefit in Triple-Negative Breast Cancer Patients With de novo Distant Metastasis

Primary Tumor Surgery for Patients with De Novo Stage IV Breast Cancer can Decrease Local Symptoms and Improve Quality of Life

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