The role of surgery in stage IV breast cancer: Clinical experiences of 62 patients

Surgery for stage IV breast cancer

Authors

Keywords:

breast cancer, metastasis, surgery, survival

Abstract

Background/Aim: The effect of surgical intervention on the quality of life and survival of patients presenting with metastatic breast cancer is a controversial issue. In this study, we aimed to reveal the survival, clinical, and pathological differences in patients with breast cancer who had metastatic disease at diagnosis and who underwent and did not undergo surgery for the primary tumor in our clinic and to evaluate the efficacy of surgical approach on the course of the disease.

Methods: In this retrospective cohort study, the data of patients with metastatic breast cancer in our clinics between January 2000 and June 2021 were retrospectively analyzed. The study included those with primary metastatic disease. The study did not include male patients, patients with primary non-breast tumors, those who died of causes unrelated to breast cancer, those who underwent surgery for metastatic foci other than the primary tumor, and those who could not be followed up regularly for various reasons. In our study, there were two groups; those who received only systemic therapy were assigned to Group 1, while those who underwent surgical treatment for the primary tumor were assigned to Group 2. The clinicopathological and survival data of the groups were examined.

Results: Surgical intervention was performed on 62 of our patients. The 4-year survival rates were higher than those who did not undergo surgery (Group 1: 59.6 [14.7%], Group 2: 83.5 [6%]). The comparison of the two groups showed a longer median survival in patients in Group 2 who underwent surgery, albeit not statistically significant (77 [11.23] months in Group 1 and 84 [18.91] months in Group 2 [P=0.16]).

Conclusion: In conclusion, our study showed that surgical treatment may have positive effects on survival.

Downloads

Download data is not yet available.

References

Bjelic-Radisic V, Fitzal F, Knauer M, Steger G, Egle D, Greil R, et al. Primary surgery versus no surgery in synchronous metastatic breast cancer: patient-reported quality-of-life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial. BMC Cancer. 2020 May 6;20(1):392. doi: 10.1186/s12885-020-06894-2. DOI: https://doi.org/10.1186/s12885-020-06894-2

Kobayashi K, Ito Y, Matsuura M, Fukada I, Horii R, Takahashi S, et al. Impact of immunohistological subtypes on the long-term prognosis of patients with metastatic breast cancer. Surg Today. 2016 Jul;46(7):821-6. doi: 10.1007/s00595-015-1252-x. DOI: https://doi.org/10.1007/s00595-015-1252-x

Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, et al. Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol. 2018 Oct;25(11):3141-9. doi: 10.1245/s10434-018-6494-6. DOI: https://doi.org/10.1245/s10434-018-6494-6

Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol. 2015 Oct;16 (13):1380-8. doi: 10.1016/S1470-2045(15)00135-7. DOI: https://doi.org/10.1016/S1470-2045(15)00135-7

Petrelli F, Barni S. Surgery of primary tumors in stage IV breast cancer: an updated meta-analysis of published studies with meta-regression. Med Oncol. 2012 Dec;29(5):3282-90. doi: 10.1007/s12032-012-0310-0. DOI: https://doi.org/10.1007/s12032-012-0310-0

O'Reilly MS, Holmgren L, Shing Y, Chen C, Rosenthal RA, Moses M, et al. Angiostatin: a novel angiogenesis inhibitor that mediates the suppression of metastases by a Lewis lung carcinoma. Cell. 1994 Oct 21;79(2):315-28. doi: 10.1016/0092-8674(94)90200-3. DOI: https://doi.org/10.1016/0092-8674(94)90200-3

Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988-2003 SEER data. Ann Surg Oncol. 2007 Aug;14(8):2187-94. doi: 10.1245/s10434-007-9438-0. DOI: https://doi.org/10.1245/s10434-007-9438-0

Fields RC, Jeffe DB, Trinkaus K, Zhang Q, Arthur C, Aft R, et al. Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis. Ann Surg Oncol. 2007 Dec;14(12):3345-51. doi: 10.1245/s10434-007-9527-0. DOI: https://doi.org/10.1245/s10434-007-9527-0

Smith I. Goals of Treatment for Patients with Metastatic Breast Cancer. Semin Oncol. 2006 Feb;33(Suppl 2):S2-5. doi: 10.1053/j.seminoncol.2005.07.030. DOI: https://doi.org/10.1053/j.seminoncol.2005.07.030

Singletary SE, Walsh G, Vauthey JN, Curley S, Sawaya R, Weber KL, et al. A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist. 2003;8(3):241-51. doi: 10.1634/theoncologist.8-3-241. DOI: https://doi.org/10.1634/theoncologist.8-3-241

Carmichael AR, Anderson ED, Chetty U, Dixon JM. Does local surgery have a role in the management of stage IV breast cancer? Eur J Surg Oncol. 2003 Feb;29(1):17-9. doi: 10.1053/ejso.2002.1339. DOI: https://doi.org/10.1053/ejso.2002.1339

Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM. Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg. 2008 May;247(5):732-8. doi: 10.1097/SLA.0b013e3181656d32. DOI: https://doi.org/10.1097/SLA.0b013e3181656d32

Retsky M, Bonadonna G, Demicheli R, Folkman J, Hrushesky W, Valagussa P. Hypothesis: Induced angiogenesis after surgery in premenopausal node-positive breast cancer patients is a major underlying reason why adjuvant chemotherapy works particularly well for those patients. Breast Cancer Res. 2004;6(4):R372-4. doi: 10.1186/bcr804. DOI: https://doi.org/10.1186/bcr804

Hortobagyi GN. Multidisciplinary management of advanced primary and metastatic breast cancer. Cancer. 1994 Jul 1;74(1 Suppl):416-23. doi: 10.1002/cncr.2820741329. DOI: https://doi.org/10.1002/cncr.2820741329

Degenshein GA, Ceccarelli F. The history of breast cancer surgery. PartI: early beginnings to Halstead. Dis Breast. 1977;3:28–36.

Fisher B. From Halsted to prevention and beyond: advances in the management of breast cancer during the twentieth century. Eur J Cancer. 1999 Dec;35(14):1963-73. doi: 10.1016/s0959-8049(99)00217-8. DOI: https://doi.org/10.1016/S0959-8049(99)00217-8

Pola AK, Soran A. Metastatik meme kanseri tanısı alanlarda primer tümör cerrahisinin yeri. Ulusal Cerrahi Dergisi. 2010;26(4):185-91.

Pathy NB, Verkooijen HM, Taib NA, Hartman M, Yip CH. Impact of breast surgery on survival in women presenting with metastatic breast cancer. Br J Surg. 2011 Nov;98(11):1566-72. doi: 10.1002/bjs.7650. DOI: https://doi.org/10.1002/bjs.7650

Warschkow R, Güller U, Tarantino I, Cerny T, Schmied BM, Thuerlimann B, et al. Improved Survival After Primary Tumor Surgery in Metastatic Breast Cancer: A Propensity-adjusted, Population-based SEER Trend Analysis. Ann Surg. 2016 Jun;263(6):1188-98. doi: 10.1097/SLA.0000000000001302. DOI: https://doi.org/10.1097/SLA.0000000000001302

Ruiterkamp J, Ernst MF. The role of surgery in metastatic breast cancer. Eur J Cancer. 2011 Sep;47 Suppl 3:S6-22. doi: 10.1016/S0959-8049(11)70142-3. DOI: https://doi.org/10.1016/S0959-8049(11)70142-3

Fitzal F, Bjelic-Radisic V, Knauer M, Steger G, Hubalek M, Balic M, et al.. Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg. 2019 Jun;269(6):1163-9. doi: 10.1097/SLA.0000000000002771. DOI: https://doi.org/10.1097/SLA.0000000000002771

Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery. 2002 Oct;132(4):620-6; discussion 626-7. doi: 10.1067/msy.2002.127544. DOI: https://doi.org/10.1067/msy.2002.127544

Downloads

Published

2024-07-03

Issue

Section

Research Article

How to Cite

1.
Taşcı H İbrahim, Varman A, Alkan S. The role of surgery in stage IV breast cancer: Clinical experiences of 62 patients: Surgery for stage IV breast cancer. J Surg Med [Internet]. 2024 Jul. 3 [cited 2024 Dec. 22];8(7):107-11. Available from: https://jsurgmed.com/article/view/7714