Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL.
Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL.
Clin Breast Cancer. 2021 Jun;21(3):170-180. doi: 10.1016/j.clbc.2020.08.008. Epub 2020 Aug 18.
There is no clear evidence of a survival benefit of resection of the primary tumor, or distant site resection (metastasectomy) in patients with stage IV breast cancer.
This retrospective analysis of stage IV breast cancer using the National Cancer Database. To evaluate variables associated with surgery at the primary site, we used univariate analyses followed by multivariate logistic regression. Consequently, we evaluated the impact of lumpectomy, mastectomy or metastasectomy on survival by conducting multivariate Cox regression survival analyses on the following groups: all stage IV patients; a subset of those with only one metastatic site; and another subset with metastasis to multiple distant sites.
A total of 54,871 stage IV breast cancer patients were included in this analysis. Variables associated with the use of surgery at the primary were: age, race, Charlson/Deyo score, insurance and facility type, involved breast quadrant, receptor status, N stage, extent of metastasis, and year of diagnosis. Survival analysis showed that both lumpectomy (median overall survival [OS], 45 months) and mastectomy (median OS, 44 months) were associated with better OS compared to no surgery (median OS, 22 months). The statistical effect was larger in the subgroup with metastasis to one site, but still significant in the subgroup with multiple metastatic sites. Distant site resection also yielded a survival benefit.
In patients with metastasis to only one site, metastasectomy was associated with better OS when that site was the liver, lung, or brain.
目前尚缺乏明确的证据表明手术切除 IV 期乳腺癌的原发肿瘤或远处转移灶（转移灶切除术）可改善患者生存。
本研究使用国家癌症数据库对 IV 期乳腺癌患者进行回顾性分析。为评估与原发灶手术相关的变量，我们首先进行单因素分析，然后进行多因素 logistic 回归分析。接着，我们通过多因素 Cox 回归生存分析，评估保乳术、乳房切除术或转移灶切除术对以下各组患者生存的影响：所有 IV 期患者；仅存在一个转移灶的亚组；存在多个远处转移灶的亚组。
共纳入 54871 例 IV 期乳腺癌患者。与原发灶手术相关的变量包括：年龄、种族、Charlson/Deyo 评分、保险类型和医疗机构类型、受累乳房象限、受体状态、N 分期、转移范围和诊断年份。生存分析显示，与未行手术治疗的患者（中位总生存期 [OS] 22 个月）相比，行保乳术（中位 OS 45 个月）和乳房切除术（中位 OS 44 个月）患者的 OS 均有改善。该统计学效应在仅有一个转移灶的亚组中更大，但在存在多个转移灶的亚组中仍然显著。远处转移灶切除术也可改善患者生存。
在仅存在一个转移灶的患者中，如果转移灶位于肝脏、肺部或脑部，转移灶切除术可改善患者 OS。
