Comprehensive Cancer Center, Unit of Oncology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
Breast Center Unit, Department of Maternal and Child's Health Sciences and of Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.
Minerva Surg. 2021 Dec;76(6):506-511. doi: 10.23736/S2724-5691.21.09007-9. Epub 2021 Aug 2.
Treatment of de-novo metastatic breast cancer is usually centered around systemic therapy, with local therapy (surgery and radiation therapy) largely reserved for palliation in patients with significant symptoms from primary tumor. The efficacy of locoregional treatment like surgery and/or radiotherapy is still controversial and the debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists.
All patients with de-novo MBC undergone surgical treatment between January 2015 and January 2020 at the Multidisciplinary Breast Center of the IRCCS A. Gemelli University Polyclinic Foundation in Rome were included in this study. The primary endpoint was overall survival (OS) after PT resection, the secondary endpoint was progression free survival (PFS). The survival analyses were done using Kaplan-Meier method. Patients and tumor characteristics were analyzed in an exploratory modality in order to identify prognostic factor.
Forty-five patients received resection of the primary breast cancer (26 mastectomy and 19 breast conserving surgery). Median age of diagnosis was 53 years old (range 25-75 years old). Median follow-up was 25.67 months. The median OS was not reached with 75% of patients alive over 2 years from PT resection. The median PFS was not reached with 64% of patients alive over 2 years from PT resection. For both PFS and OS only the triple negative (TN) immunophenotype appears to be a prognostically unfavorable factor in multivariate analysis.
In view of the low number of disease progression events and deaths, although our results are preliminary, surgical treatment of primary breast cancer in metastatic setting seems to be an option after systemic therapies in luminal and HER2 positive breast cancer. Randomized prospective trials for each immunophenotype are necessary in order to confirm this evidence.
新诊断转移性乳腺癌的治疗通常以全身治疗为中心，局部治疗（手术和放疗）主要用于缓解原发性肿瘤有明显症状的患者。手术和/或放疗等局部区域治疗的疗效仍存在争议，关于新诊断转移性乳腺癌（MBC）患者原发肿瘤（PT）手术切除的争论仍在继续。
本研究纳入了 2015 年 1 月至 2020 年 1 月期间在罗马 IRCCS A. Gemelli 大学医学中心多学科乳腺中心接受手术治疗的所有新诊断为 MBC 的患者。主要终点是 PT 切除后的总生存（OS），次要终点是无进展生存（PFS）。使用 Kaplan-Meier 法进行生存分析。以探索性方式分析患者和肿瘤特征，以确定预后因素。
45 例患者接受了原发性乳腺癌切除术（26 例乳房切除术和 19 例保乳手术）。诊断时的中位年龄为 53 岁（范围 25-75 岁）。中位随访时间为 25.67 个月。75%的患者在 PT 切除后 2 年以上仍存活，中位 OS 未达到。64%的患者在 PT 切除后 2 年以上仍存活，中位 PFS 未达到。在多变量分析中，只有三阴性（TN）免疫表型似乎是预后不良的因素。
鉴于疾病进展事件和死亡的数量较少，尽管我们的结果是初步的，但在全身治疗后，转移性背景下的原发性乳腺癌手术治疗似乎是 luminal 和 HER2 阳性乳腺癌的一种选择。为了证实这一证据，需要针对每种免疫表型进行随机前瞻性试验。
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