Babiera Gildy V, Rao Roshni, Feng Lei, Meric-Bernstam Funda, Kuerer Henry M, Singletary S Eva, Hunt Kelly K, Ross Merrick I, Gwyn Karin M, Feig Barry W, Ames Frederick C, Hortobagyi Gabriel N
Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
Ann Surg Oncol. 2006 Jun;13(6):776-82. doi: 10.1245/ASO.2006.03.033. Epub 2006 Apr 17.
Currently, therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed; the primary tumor is treated only when it causes symptoms. A recent review suggested that surgery may improve long-term survival in such patients. We evaluated the effect of surgery in such patients on long-term survival and disease progression.
We reviewed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Information collected included demographics, tumor characteristics, site(s) of metastases, type/date of operation, use of radiotherapy, chemotherapy and hormonal therapy, disease progression (time to progression and location of progression) in the first year after diagnosis, and last follow-up. Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients.
Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P=.12; relative risk, .50; 95% confidence interval, .21-1.19) and a significant improvement in metastatic progression-free survival (P=.0007; relative risk, .54; 95% confidence interval, .38-.77).
Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.
目前，对于伴有原发性肿瘤完整的IV期乳腺癌患者的治疗是针对转移灶的；仅当原发性肿瘤引起症状时才对其进行治疗。最近的一项综述表明，手术可能会改善此类患者的长期生存率。我们评估了此类患者手术对长期生存和疾病进展的影响。
我们回顾了1997年至2002年在我院接受治疗的所有伴有原发性肿瘤完整的IV期乳腺癌患者的记录。收集的信息包括人口统计学资料、肿瘤特征、转移部位、手术类型/日期、放疗、化疗和激素治疗的使用情况、诊断后第一年的疾病进展（进展时间和进展部位）以及末次随访。比较了手术患者和非手术患者的总生存和无转移进展生存情况。
在确定的224例患者中，82例（37%）接受了原发性肿瘤的手术切除（39例[48%]行区段乳房切除术，43例[52%]行乳房切除术），142例（63%）未接受手术治疗而接受了其他治疗。中位随访时间为32.1个月。在对其他协变量进行调整后, 手术与总生存改善趋势相关（P = 0.12；相对风险，0.50；95%置信区间，0.21 - 1.19），且与无转移进展生存的显著改善相关（P = 0.0007；相对风险，0.54；95%置信区间，0.38 - 0.77）。
对于同步IV期乳腺癌患者，切除完整的原发性肿瘤与无转移进展生存的改善相关。需要进行前瞻性研究来验证这些发现。
