Sun Yanbo, Ma Hao, Li Yingjie, Zhou Can
Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan'xi, China.
School of Medicine, Xi'an Jiaotong University Health Science Center, Xi'an, Shaan'xi, China.
Front Oncol. 2025 May 13;15:1590246. doi: 10.3389/fonc.2025.1590246. eCollection 2025.
Due to the controversy in the therapeutic effect of locoregional surgery in primary tumors for patients with de novo stage IV breast cancer, the aim of this study was to evaluate the effect of locoregional surgery on overall survival in patients with de novo stage IV breast cancer.
A computer-based search of PUBMED, Embase, and American Society of Oncology (ASCO) annual meetings abstracts was conducted to identify the prospective trials of the combination of locoregional surgery in primary tumors and systemic therapy in comparison with standard systemic therapy alone for patients with de novo stage IV breast cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated by universal inverse variance and combined across articles. Random-effects model and subgroup analyses were performed to ascertain the origin of this heterogeneity.
A total of 2029 patients from 8 studies were included, with 1014 patients (49.98%) underwent locoregional surgery in primary tumors (surgery group) and 1015 ones (50.02%) with standard systemic therapy alone (no surgery group). Compared to patients in the no surgery group, participants with ER/PR positive breast cancer in the surgery group had improved overall survival (OS) (HR=0.77, 95%CI 0.55-0.93, P=0.01), and improved locoregional progression-free survival (HR=0.36, 95%CI 0.14-0.95, P=0.04) for all participants in the surgery group. And patients with bone-only metastases in the surgery group had insignificantly favorable OS than those in no surgery group (HR=0.70, 95%CI, 0.47-1.04, P=0.08).
Our study demonstrated that locoregional surgery in primary tumors was associated with improved OS for participants with ER/PR positive stage IV breast cancer, and locoregional surgery in primary tumors could be worthy of clinical recommendation for patients with ER/PR positive de novo stage IV breast cancer.
由于原发性肿瘤局部区域手术对初治IV期乳腺癌患者的治疗效果存在争议，本研究旨在评估原发性肿瘤局部区域手术对初治IV期乳腺癌患者总生存期的影响。
通过计算机检索PUBMED、Embase和美国肿瘤学会（ASCO）年会摘要，以确定原发性肿瘤局部区域手术联合全身治疗与单纯标准全身治疗相比，用于初治IV期乳腺癌患者的前瞻性试验。采用通用逆方差法计算风险比（HR）和95%置信区间（CI），并对各文章结果进行合并。进行随机效应模型和亚组分析以确定这种异质性的来源。
共纳入8项研究中的2029例患者，其中1014例患者（49.98%）接受了原发性肿瘤局部区域手术（手术组），1015例患者（50.02%）仅接受标准全身治疗（非手术组）。与非手术组患者相比，手术组中雌激素受体/孕激素受体（ER/PR）阳性乳腺癌患者的总生存期（OS）得到改善（HR=0.77，95%CI 0.55-0.93，P=0.01），且手术组所有患者的局部区域无进展生存期也得到改善（HR=0.36，95%CI 0.14-0.95，P=0.04）。手术组中仅发生骨转移的患者的OS虽优于非手术组，但差异无统计学意义（HR=0.70，95%CI 0.47-1.04，P=0.08）。
我们的研究表明，原发性肿瘤局部区域手术可改善ER/PR阳性IV期乳腺癌患者的OS，对于ER/PR阳性初治IV期乳腺癌患者，原发性肿瘤局部区域手术值得临床推荐。
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