Predicting the survival benefit of local surgery in patients aged 70 years or older with stage IV breast cancer: A population-based analysis

Abstract

The aim of this study was to establish individualized nomograms to predict survival outcomes in older female patients with stage IV breast cancer who did or did not undergo local surgery, and to determine which patients could benefit from surgery. Methods: A total of 3,129 female patients with stage IV breast cancer aged !70 years between 2010 and 2015 were included in the Surveillance, Epidemiology, and End Results program. Multivariate Cox regression analysis was used to identify risk factors for overall survival (OS) and breast cancer-specific survival (BCSS). Survival analysis was performed using the KaplaneMeier plot and log-rank test. Nomograms and risk stratification models were constructed. Results: Patients who underwent surgery had better OS (HR ¼ 0.751, 95% CI [0.668e0.843], P < 0.001) and BCSS (HR ¼ 0.713, 95% CI [0.627e0.810], P < 0.001) than patients who did not undergo surgery. Patients with human epidermal growth factor receptor 2-positive, lung or liver metastases may not benefit from surgery. In the stratification model, low-risk patients benefited from surgery (OS, HR ¼ 0.688, 95% CI [0.568e0.833], P < 0.001; BCSS, HR ¼ 0.632, 95% CI [0.509e0.784], P < 0.001), while patients in the high-risk group had similar outcomes (OS, HR ¼ 0.920, 95% CI [0.709e1.193], P ¼ 0.509; BCSS, HR ¼ 0.953, 95% CI [0.713e1.275], P ¼ 0.737). Conclusion: Older female patients with stage IV breast cancer who underwent surgery had better OS and BCSS than those who did not in each specific subgroup. Patients in low-or intermediate-risk group benefit from surgery while those in the high-risk group do not.

Consenso mexicano de cáncer mamario. Manejo del cáncer de mama avanzado

“…Se observó que todos los pacientes se beneficiaron de la cirugía, con una mediana de SG, cirugía vs. no cirugía de 72.7 vs. 42.9 meses, 47.3 vs. 30.4 meses, 23.8 vs. 14.4 meses (todos p < 0.001) en la subdivisión por grupos I, II y III, respectivamente 114 . Por lo tanto, parece ser una alternativa razonable que puede ser discutida con aquellas pacientes con características clínicas favorables como un buen estado general, menores de 55 años, enfermedad con RH positivos, HER2 neu negativo, volumen tumoral limitado, predominantemente con metástasis óseas, sin metástasis cerebrales y en las que se considere poder obtener márgenes negativos independientemente del tipo de cirugía realizada que debe incluir forzosamente el control del primario y de la axila, debiéndose valorar el uso de radioterapia locorregional posterior a esta e incluso la reconstrucción mamaria, ya sea inmediata o diferida, individualizando el caso y discutiéndose todos estos puntos en un grupo multidisciplinario y con la paciente [115][116][117][118][119] .…”

Mexican breast cancer consensus. Management of advanced breast cancer

“…All patients were observed to benefit from surgery, with a median OS with surgery versus no surgery of 72.7 versus 42.9 months, 47.3 versus 30.4 months, and 23.8 versus 4.4 months (all p < 0.001) in the subdivision by groups I, II, and III, respectively 114 . Therefore, it appears to be a reasonable alternative that can be discussed with those patients with favorable clinical characteristics such as good general condition, younger than 55 years, HR-positive/HER2 neu-negative disease, limited tumor volume, predominantly with bone metastases, without brain metastases, and in whom obtaining negative margins is considered possible regardless of the type of surgery performed, which should necessarily include control of the primary tumor and axilla; in addition, the use of locoregional radiotherapy after surgery, and even breast reconstruction, whether immediate or deferred, should be evaluated, with the case being individualized and all these points being discussed in a multidisciplinary group and with the patient [115][116][117][118][119] .…”