Gnerlich Jennifer, Jeffe Donna B, Deshpande Anjali D, Beers Courtney, Zander Christina, Margenthaler Julie A
Department of Surgery, Washington University School of Medicine, 660 S Euclid, Campus, Box 8109, St. Louis, Missouri 63110, USA.
Ann Surg Oncol. 2007 Aug;14(8):2187-94. doi: 10.1245/s10434-007-9438-0. Epub 2007 May 24.
Primary treatments for stage IV breast cancer are chemotherapy and radiation, with surgery usually reserved for tumor-related complications. We sought to determine whether surgical removal of the primary tumor provides a survival advantage for women with metastatic breast cancer.
We conducted a retrospective, population-based cohort study by using the 1988-2003 Surveillance, Epidemiology, and End Results (SEER) program data. By use of multivariate Cox regression models, overall survival in women with stage IV disease was compared between women who underwent surgical excision of their breast tumor with women who did not, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores (accounting for variables associated with the likelihood of having surgery).
Of 9734 SEER patients with stage IV breast cancer, 47% underwent breast cancer surgery and 53% did not. Median survival was longer for women who had surgery than for women who did not, both among women who were alive at the end of the study period (36.00 vs. 21.00 months; P < .001) and among women who had died during follow-up (18.00 vs. 7.00 months; P < .001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery were less likely to die during the study period compared with women who did not undergo surgery (adjusted hazard ratio, .63, 95% confidence interval, .60-.66).
Analysis of the 1988-2003 SEER data indicated that extirpation of the primary breast tumor in patients with stage IV disease was associated with a marked reduction in risk of dying after controlling for variables associated with survival.
IV期乳腺癌的主要治疗方法是化疗和放疗，手术通常用于治疗与肿瘤相关的并发症。我们试图确定手术切除原发性肿瘤是否能为转移性乳腺癌女性患者带来生存优势。
我们利用1988 - 2003年监测、流行病学和最终结果（SEER）项目数据进行了一项基于人群的回顾性队列研究。通过多变量Cox回归模型，比较了接受乳腺肿瘤手术切除的IV期疾病女性与未接受手术切除的女性的总生存率，同时控制潜在的混杂人口统计学、肿瘤和治疗相关变量以及倾向评分（考虑与手术可能性相关的变量）。
在9734例SEER IV期乳腺癌患者中，47%接受了乳腺癌手术，53%未接受手术。在研究期末仍存活的女性中，接受手术的女性中位生存期长于未接受手术的女性（36.00个月对21.00个月；P <.001）；在随访期间死亡的女性中，情况也是如此（18.00个月对7.00个月；P <.001）。在控制潜在的混杂变量和倾向评分后，与未接受手术的女性相比，接受手术的患者在研究期间死亡的可能性更小（调整后的风险比为0.63，95%置信区间为0.60 - 0.66）。
对1988 - 2003年SEER数据的分析表明，在控制与生存相关的变量后，IV期疾病患者原发性乳腺肿瘤的切除与死亡风险的显著降低相关。
