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Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary Tumor

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Abstract

Background

Currently, therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed; the primary tumor is treated only when it causes symptoms. A recent review suggested that surgery may improve long-term survival in such patients. We evaluated the effect of surgery in such patients on long-term survival and disease progression.

Methods

We reviewed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Information collected included demographics, tumor characteristics, site(s) of metastases, type/date of operation, use of radiotherapy, chemotherapy and hormonal therapy, disease progression (time to progression and location of progression) in the first year after diagnosis, and last follow-up. Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients.

Results

Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P = .12; relative risk, .50; 95% confidence interval, .21–1.19) and a significant improvement in metastatic progression-free survival (P = .0007; relative risk, .54; 95% confidence interval, .38–.77).

Conclusions

Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.

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Acknowledgments

The authors thank Stephanie Deming for her editorial assistance, Marlen Banda for assistance with manuscript preparation, and Alam Khuwaja for data management. Supported by the Nellie B. Connally Breast Cancer Research Fund.

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Authors and Affiliations

  1. Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA

    Gildy V. Babiera MD, Roshni Rao MD, Funda Meric-Bernstam MD, Henry M. Kuerer MD, S. Eva Singletary MD, Kelly K. Hunt MD, Merrick I. Ross MD, Barry W. Feig MD & Frederick C. Ames MD

  2. Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA

    Lei Feng MS

  3. Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA

    Karin M. Gwyn MD & Gabriel N. Hortobagyi MD

Authors
  1. Gildy V. Babiera MD
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  2. Roshni Rao MD
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  3. Lei Feng MS
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  4. Funda Meric-Bernstam MD
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  5. Henry M. Kuerer MD
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  6. S. Eva Singletary MD
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  7. Kelly K. Hunt MD
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  8. Merrick I. Ross MD
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  9. Karin M. Gwyn MD
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  10. Barry W. Feig MD
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  11. Frederick C. Ames MD
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  12. Gabriel N. Hortobagyi MD
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Corresponding author

Correspondence to Gildy V. Babiera MD.

Additional information

Presented in part at the Annual Meeting of the Society of Surgical Oncology, Atlanta, Georgia, March 3–6, 2005.

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Babiera, G.V., Rao, R., Feng, L. et al. Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary Tumor. Ann Surg Oncol 13, 776–782 (2006). https://doi.org/10.1245/ASO.2006.03.033

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  • DOI: https://doi.org/10.1245/ASO.2006.03.033

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