Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
Department of Rehabilitation Science, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
Eur J Surg Oncol. 2018 Oct;44(10):1504-1512. doi: 10.1016/j.ejso.2018.08.002. Epub 2018 Aug 11.
The impact of primary tumor resection (PTR) on survival is still controversial in stage IV breast cancer. This systematic review and meta-analysis aimed to evaluate the impact of PTR on overall survival (OS) in stage IV breast cancer.
Comprehensive literature search was conducted to identify studies comparing PTR with no PTR for stage IV breast cancer. The quality of the studies was assessed using Cochrane risk of bias tool and Newcastle-Ottawa Scale. We used subgroup and meta-regression analysis to assess the contribution of demographic and clinical factors to heterogeneity.
Data on 714 patients in 3 randomized controlled trials (RCTs) and 67,272 patients in 30 observational studies were included. One RCT was terminated early due to poor recruitment, and the remaining two RCTs' design were different, thus RCTs were only performed systematic review without meta-analysis. The pooled outcomes of 30 observational studies showed PTR significantly improved OS (HR = 0.65; 95%CI, 0.61 to 0.70, P < 0.001, I = 80%). Additionally, PTR was associated with better distant progression-free survival (HR = 0.42; 95%CI, 0.29 to 0.60) but did not impact progression-free survival. Subgroup analysis showed PTR benefit in patients who had only one metastatic site (HR = 0.62, 95%CI. 0.48 to 0.81), bone-only metastasis (HR = 0.61, 95%CI. 0.37 to 1.00), with negative margin (HR = 0.61, 95%CI. 0.58 to 0.65).
PTR should not be part of routine clinical practice in stage IV breast cancer but might be performed in selected patients. Our findings highlight PTR might be valuable in patients with limited disease burden or attaining clear margin.
在 IV 期乳腺癌中，原发肿瘤切除术（PTR）对生存的影响仍存在争议。本系统评价和荟萃分析旨在评估 PTR 对 IV 期乳腺癌患者总生存（OS）的影响。
全面检索文献，以确定比较 IV 期乳腺癌 PTR 与无 PTR 的研究。使用 Cochrane 偏倚风险工具和纽卡斯尔-渥太华量表评估研究质量。我们使用亚组和荟萃回归分析来评估人口统计学和临床因素对异质性的贡献。
纳入了 3 项随机对照试验（RCT）中 714 例患者和 30 项观察性研究中 67272 例患者的数据。一项 RCT 因招募不佳而提前终止，其余两项 RCT 的设计不同，因此仅对 RCT 进行了系统评价而未进行荟萃分析。30 项观察性研究的汇总结果表明，PTR 显著改善了 OS（HR=0.65；95%CI，0.61 至 0.70，P<0.001，I=80%）。此外，PTR 与更好的远处无进展生存期相关（HR=0.42；95%CI，0.29 至 0.60），但不影响无进展生存期。亚组分析表明，PTR 对仅存在一个转移部位（HR=0.62，95%CI，0.48 至 0.81）、骨转移（HR=0.61，95%CI，0.37 至 1.00）和切缘阴性的患者有益（HR=0.61，95%CI，0.58 至 0.65）。
PTR 不应作为 IV 期乳腺癌常规临床实践的一部分，但可在选择的患者中进行。我们的研究结果表明，PTR 在疾病负担有限或达到明确切缘的患者中可能具有价值。
