Hunan Cancer Hospital, Central South University, Changsha, China.
Department of Breast Cancer Surgical Oncology, Hunan Cancer Hospital, Changsha, China.
BMJ Open. 2022 Feb 1;12(2):e054135. doi: 10.1136/bmjopen-2021-054135.
Although primary tumour surgery could prolong survival for patients with stage IV breast cancer, how to select candidates for primary tumour surgery is still a challenging problem for medical oncologists.
This study is a retrospective database study.
In this study, we aimed at evaluating the primary site surgery effect and select the beneficial subgroups. 13 618 patients with stage IV breast cancer, diagnosed between 2010 and 2015, were collected from SEER*Stat database.
Based on the local surgery at primary tumour site, patients were categorised into three groups: primary tumour surgery performed group, recommended for primary tumour surgery but refused (RBR) group and surgery not recommended (NR) group.
All-cause survival and breast cancer-specific survival (BCSS).
Univariate Cox regression analyses showed that, compared with surgery group, patients in non-surgery (RBR and NR) groups tend to be older, T4, N0/NX, triple-negative and visceral metastatic. For both all-cause survival and BCSS, non-surgery, advanced T stage, triple-negative BC (TNBC) and visceral metastases were significant risk factors. Primary tumour surgery showed benefits for both all-cause survival (HR=0.44, 95% CI=0.39-0.49, p<0.0001) and BCSS (HR=0.43, 95% CI=0.38-0.49, p<0.0001). However, after propensity score matching, primary tumour surgery failed to demonstrate significant benefits for TNBC (HR=0.96, 95% CI=0.60-1.53, p=0.851) and patients with visceral metastases (HR=0.90, 95% CI=0.60-1.36, p=0.62).
Surgery was associated with prolonged survival in stage IV breast cancers, but not in patients with TNBC and visceral metastases.
尽管原发肿瘤手术可以延长 IV 期乳腺癌患者的生存时间，但如何选择原发肿瘤手术的候选者仍是肿瘤内科医生面临的挑战。
本研究为回顾性数据库研究。
本研究旨在评估原发部位手术的效果，并选择获益亚组。从 SEER*Stat 数据库中收集了 13618 例 2010 年至 2015 年间诊断为 IV 期乳腺癌的患者。
根据原发肿瘤部位的局部手术，将患者分为三组：行原发肿瘤手术组、建议行原发肿瘤手术但拒绝（RBR）组和不建议手术（NR）组。
全因生存和乳腺癌特异性生存（BCSS）。
单因素 Cox 回归分析显示，与手术组相比，非手术组（RBR 和 NR）患者年龄更大，T4、N0/NX、三阴性和内脏转移。全因生存和 BCSS 均显示，非手术、晚期 T 分期、三阴性乳腺癌（TNBC）和内脏转移是显著的危险因素。原发肿瘤手术对全因生存（HR=0.44，95%CI=0.39-0.49，p<0.0001）和 BCSS（HR=0.43，95%CI=0.38-0.49，p<0.0001）均有获益。然而，在倾向评分匹配后，原发肿瘤手术对 TNBC（HR=0.96，95%CI=0.60-1.53，p=0.851）和有内脏转移的患者（HR=0.90，95%CI=0.60-1.36，p=0.62）均未显示出显著获益。
手术与 IV 期乳腺癌患者的生存延长相关，但与 TNBC 和内脏转移患者无关。
