Presence of symptoms and timing of surgery do not affect the prognosis of patients with primary metastatic breast cancer

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTThere are no financial disclosures or conflicts of interest from any of the authors.This work had no specific funding.No acknowledgements. Keywords:Breast neoplasms -Neoplasm metastasis -Surgery -Confounding Factors -Aims Though most studies on surgical resection of the breast tumor in patients with primary distant metastatic breast cancer (MBC) indicated that surgery is associated with prolonged overall survival, some state that this effect has been confounded by indication and timing of surgery. In this study we analysed these possible confounders and their relation to overall survival. MethodsTo determine the impact of potential confounders, individual charts of 279 patients with primary MBC were reviewed. ResultsThe median survival in patients treated with surgery of the breast tumor was 39 months, compared to 15 months for those without surgery (p<0.0001).The median survival of patients with symptomatic metastatic disease (n=112) was 19 months, compared to 22 months for those without symptomatic disease (n=167) (p=0.15). Patients who received surgery and whose metastases were detected before surgery of the breast tumor had taken place (n=40) had a median survival of 38 months, compared to 40 months for patients in whom the metastatic disease was diagnosed after surgery (n=43) (p=0.81). ConclusionPresence of symptomatic metastatic disease was no significant prognostic factor for patients with distant metastasis at diagnosis, neither was the timing of surgery. It is unlikely that the prolonged survival after surgery is explained by these potentials confounders.

Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma

“…Cady et al [23] suggested that most of the survival advantage for patients undergoing surgery is explained by case selection bias, meaning that patients with a good response to initial systemic therapy are also more likely to undergo surgery than those with a poor response. There are numerous studies showing that timing of surgery was no significant prognostic factor for patients with MBC [11,22,24,40]. Similar to the reports in literature we could not find the importance of timing of LRT on survival rates.…”

“…LRT in these retrospective series was more frequently used in selected patients with better prognostic profile [7e11, 13,17,22]. These patients were significantly younger, had fewer comorbidities, more often had hormone receptor positive disease, had a lower stage and lower grade tumors, had fewer sites of metastases, less often with visceral metastases, less likely to have symptomatic metastases and more often treated with combined locoregional RT and/or systemic treatment [6e9, 11,13,21,40]. Similar to the literature, the use of LRT was more common in our patients with better prognostic features including T1e2 tumors and solitary metastases.…”

De novo Stage IV breast cancer: Breast conserving resection of the primary tumor?

“…The timing of surgery in relation to the diagnosis of metastases and use of systemic therapy has not always been specified in the published retrospective literature, although several authors have attempted to address it , with varying conclusions. For the present discussion, the situation of metastatic disease diagnosed in the post‐operative period is not pertinent, since the surgical decision has already been made for these patients.…”

Surgical Management of De Novo Stage IV Breast Cancer

“…Surgical Timing: The timing of surgery in relation to the diagnosis of metastases and use of systemic therapy has not always been specified in the published retrospective literature, although several authors have attempted to address it, 21,29,38,39 with varying conclusions. This is a source of bias in that women who are diagnosed with metastases only after they have undergone surgery for the primary tumor most likely have asymptomatic (and therefore lower-volume) metastases.…”