Department of Medical Oncology, Hospital Clinico Universitario, Avda Blasco Ibanez s/n, 46018 INCLIVA, Valencia, Spain.
Breast. 2011 Dec;20(6):548-54. doi: 10.1016/j.breast.2011.06.005. Epub 2011 Aug 3.
Resection of intact primary tumor is controversial in metastatic breast cancer patients. The aim of this study is to review the impact of surgical resection of primary tumor on overall survival and to assess the role of timing of surgery on survival rates.
208 patients with metastatic breast cancer diagnosed between 1982 and 2005 in the Hospital Clinico of Valencia (Spain) were analysed. Exclusion criteria were age >80, PS 3-4, Charlson score 3 or follow-up < 90 days. 123 of these underwent surgery and 85 did not. In order to assess the role of timing, the "surgery" cohort was divided into two sub-groups: "before" (n = 78) or "after" (n = 45) diagnosis of disseminated disease.
In the surgery group, patients underwent mastectomy with axillary dissection (82.9%), without axillary dissection (8.9%) and conservative surgery (8.1%). After a median follow-up of 29.68 months, median OS in the "surgery" and the "non-surgery" groups were, 40.4 and 24.3 months. Removal of the primary tumor therefore had a significant positive impact on survival rates (p < 0.001). Benefits of surgery were observed mainly in patients with visceral disease (p = 0.005); no statistical differences were found in those with bone disease (p = 0.79). Univariate analysis for overall survival (OS) identified surgery, performance status, clinical T stage, hormone receptors and number and type of metastases as variables that impacted on survival. In the multivariate test, only resection of primary tumor and estrogen receptors maintained statistical significance, surgery having a protective effect with an HR 0.52 (95% CI 0.35-0.77). No differences in survival were found between the two sub-groups according to the timing of surgery: "before" vs "after"(p = 0.996).
Resection of primary tumor should be considered not only as a palliative or preventive strategy but also as an approach that possibly contributes to the control of the disease in selected patients.
在转移性乳腺癌患者中，完整原发肿瘤的切除存在争议。本研究旨在回顾手术切除原发肿瘤对总生存期的影响，并评估手术时机对生存率的影响。
分析了 1982 年至 2005 年间在西班牙瓦伦西亚临床医院诊断为转移性乳腺癌的 208 例患者。排除标准为年龄>80 岁、PS 3-4、Charlson 评分 3 或随访<90 天。其中 123 例接受了手术，85 例未接受手术。为了评估时机的作用，将“手术”组分为两个亚组：“诊断前”（n=78）或“诊断后”（n=45）。
在手术组中，患者接受了乳房切除术伴腋窝清扫术（82.9%）、无腋窝清扫术（8.9%）和保留乳房手术（8.1%）。在中位随访 29.68 个月后，“手术”组和“非手术”组的中位总生存期分别为 40.4 和 24.3 个月。因此，原发肿瘤的切除对生存率有显著的积极影响（p<0.001）。手术的益处主要见于有内脏疾病的患者（p=0.005）；而在有骨疾病的患者中未发现统计学差异（p=0.79）。单因素分析显示，手术、体能状态、临床 T 分期、激素受体以及转移的数量和类型是影响生存的变量。在多因素检验中，只有原发肿瘤切除和雌激素受体仍有统计学意义，手术具有保护作用，风险比为 0.52（95%可信区间为 0.35-0.77）。根据手术时机，两组之间的生存无差异：“诊断前”与“诊断后”（p=0.996）。
原发肿瘤的切除不仅应被视为一种姑息或预防策略，还应被视为一种可能有助于控制疾病的方法，尤其适用于某些患者。
