Warschkow Rene, Güller Ulrich, Tarantino Ignazio, Cerny Thomas, Schmied Bruno M, Thuerlimann Beat, Joerger Markus
*Department of Surgery, Cantonal Hospital, St. Gallen, Switzerland†Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany‡Department of Medical Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland§University Clinic for Visceral Surgery and Medicine, University Hospital Berne, Berne, Switzerland¶Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany||Breast Center, Cantonal Hospital, St. Gallen, Switzerland.
Ann Surg. 2016 Jun;263(6):1188-98. doi: 10.1097/SLA.0000000000001302.
There is ongoing debate about nonpalliative primary tumor surgery in metastatic breast cancer patients. This issue has become even more relevant with the introduction of increasingly sensitive imaging modalities.
Metastatic breast cancer patients were identified in the SEER registry between 1998 and 2009. The effect of primary tumor surgery on overall and cancer-specific mortality using risk-adjusted Cox proportional hazard regression modeling and stratified propensity score matching was assessed.
Overall, 16,247 women with metastatic breast cancer were included. Of those 7600 women underwent primary tumor surgery although 8647 did not have any surgery at all. Primary tumor surgery decreased from 62.0% in 1998 to 39.1% in 2009 (P < 0.001). Primary tumor surgery was associated with decreased overall mortality (hazard ratio (HR) = 0.53, 95% CI 0.50-0.55, P < 0.001) and cancer-specific mortality (HR = 0.51, 95% CI 0.48-0.54, P < 0.001) in the propensity score-matched model. The benefit of primary tumor surgery increased from 1998 to 2009 for overall mortality (1998: HR = 0.72, 95% CI 0.59-0.89, 2009: HR = 0.42, 95% CI 0.35-0.50) and cancer-specific mortality (1998: HR = 0.72, 95% CI 0.58-0.89, 2009: HR = 0.40, 95% CI 0.33-0.48).
The present study-the first population-based analysis using propensity score methods-provides evidence of a favorable impact of primary tumor surgery on mortality in metastatic breast cancer patients. Most importantly, the benefit of primary tumor surgery increased over time from 1998 to 2009. Although the final results of ongoing randomized studies are awaited, currently available evidence should be discussed with metastatic breast cancer patients.
关于转移性乳腺癌患者的非姑息性原发性肿瘤手术一直存在争议。随着越来越敏感的成像方式的引入，这个问题变得更加重要。
在1998年至2009年的监测、流行病学与最终结果（SEER）登记处中识别出转移性乳腺癌患者。使用风险调整的Cox比例风险回归模型和分层倾向评分匹配评估原发性肿瘤手术对总体死亡率和癌症特异性死亡率的影响。
总体而言，纳入了16247名转移性乳腺癌女性患者。其中7600名女性接受了原发性肿瘤手术，而8647名女性根本没有进行任何手术。原发性肿瘤手术从1998年的62.0%下降到2009年的39.1%（P < 0.001）。在倾向评分匹配模型中，原发性肿瘤手术与总体死亡率降低相关（风险比（HR）= 0.53，95%置信区间0.50 - 0.55，P < 0.001）和癌症特异性死亡率降低相关（HR = 0.51，95%置信区间0.48 - 0.54，P < 0.001）。从1998年到2009年，原发性肿瘤手术对总体死亡率（1998年：HR = 0.72，95%置信区间0.59 - 0.89，2009年：HR = 0.42，95%置信区间0.35 - 0.50）和癌症特异性死亡率（1998年：HR = 0.72，95%置信区间0.58 - 0.89，2009年：HR = 0.40，95%置信区间0.33 - 0.48）的益处有所增加。
本研究——首次使用倾向评分方法进行的基于人群的分析——提供了证据表明原发性肿瘤手术对转移性乳腺癌患者的死亡率有积极影响。最重要的是，从1998年到2009年，原发性肿瘤手术的益处随着时间的推移而增加。尽管正在等待正在进行的随机研究的最终结果，但目前可得的证据应与转移性乳腺癌患者进行讨论。
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