Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Clin Breast Cancer. 2018 Oct;18(5):e1037-e1044. doi: 10.1016/j.clbc.2018.05.005. Epub 2018 May 28.
Several studies have suggested that primary tumor removal improved overall survival for patients with stage IV breast cancer. However, the survival benefit of local treatment remains controversial. The purpose of the present study was to determine whether surgical removal of the primary tumor provides survival benefits to patients with stage IV breast cancer.
We retrospectively reviewed the medical records of 155 patients with an initial diagnosis of stage IV breast cancer at Seoul National University Bundang Hospital from 2003 to 2014. Kaplan-Meier analysis was used to estimate the median survival. The log-rank test was used to compare differences in patient and tumor characteristics. Multivariate Cox regression analysis for survival was used, controlling for potential confounding variables.
Of 155 patients with stage IV breast cancer, 95 (61%) underwent surgical removal of the primary tumor. The median follow-up period was 59 months (95% confidence interval [CI], 45-73 months). The median survival was longer for the patients with a better response to chemotherapy (70 vs. 47 months; P = .010) and for those who had undergone surgery (118 vs. 28 months; P < .001) than for those who without a better chemotherapy response or surgery. The median survival of the patients who received radiotherapy was better than that of the patients who did not (65 vs. 39 months; P = .004). Patients with luminal A cancer had a median survival of 118 months, the longest compared with those with other subtypes (P = .001). In addition, patients with distant metastasis at a single site had a longer median survival than did those with multiple metastatic sites. The multivariate Cox regression analysis revealed that fewer distant metastases, surgery of the primary tumor, a better response to chemotherapy, and luminal A subtype were significant independent predictors of survival.
Our results showed that primary tumor removal was independently associated with improvement in survival. Therefore, surgical management for the primary tumor could be considered more actively in patients with stage IV breast cancer.
多项研究表明，对 IV 期乳腺癌患者进行原发肿瘤切除术可改善总生存期。然而，局部治疗的生存获益仍存在争议。本研究旨在确定 IV 期乳腺癌患者行原发肿瘤切除术是否可带来生存获益。
我们回顾性分析了 2003 年至 2014 年期间在首尔国立大学盆唐医院初诊为 IV 期乳腺癌的 155 例患者的病历资料。采用 Kaplan-Meier 分析估计中位生存期。采用对数秩检验比较患者和肿瘤特征的差异。采用多变量 Cox 回归分析控制潜在混杂因素对生存的影响。
在 155 例 IV 期乳腺癌患者中，95 例（61%）接受了原发肿瘤切除术。中位随访时间为 59 个月（95%置信区间：45-73 个月）。化疗反应更好（70 个月 vs. 47 个月；P =.010）和接受手术（118 个月 vs. 28 个月；P <.001）的患者中位生存期较长，而化疗反应不佳或未手术的患者中位生存期较短。接受放疗的患者中位生存期优于未放疗的患者（65 个月 vs. 39 个月；P =.004）。 luminal A 型患者的中位生存期最长，为 118 个月，明显长于其他亚型（P =.001）。此外，单一远处转移部位的患者中位生存期长于多发远处转移部位的患者。多变量 Cox 回归分析显示，远处转移灶数目较少、行原发肿瘤切除术、化疗反应较好和 luminal A 型为生存的独立预测因素。
本研究结果表明，原发肿瘤切除术与生存改善独立相关。因此，对于 IV 期乳腺癌患者，原发肿瘤的手术治疗可以更积极地考虑。
