Surgical Removal of the Primary Tumor Increases Overall Survival in Patients With Metastatic Breast Cancer: Analysis of the 1988–2003 SEER Data
- 24 May 2007
- journal article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 14 (8), 2187-2194
- https://doi.org/10.1245/s10434-007-9438-0
Abstract
Primary treatments for stage IV breast cancer are chemotherapy and radiation, with surgery usually reserved for tumor-related complications. We sought to determine whether surgical removal of the primary tumor provides a survival advantage for women with metastatic breast cancer. We conducted a retrospective, population-based cohort study by using the 1988-2003 Surveillance, Epidemiology, and End Results (SEER) program data. By use of multivariate Cox regression models, overall survival in women with stage IV disease was compared between women who underwent surgical excision of their breast tumor with women who did not, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores (accounting for variables associated with the likelihood of having surgery). Of 9734 SEER patients with stage IV breast cancer, 47% underwent breast cancer surgery and 53% did not. Median survival was longer for women who had surgery than for women who did not, both among women who were alive at the end of the study period (36.00 vs. 21.00 months; P < .001) and among women who had died during follow-up (18.00 vs. 7.00 months; P < .001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery were less likely to die during the study period compared with women who did not undergo surgery (adjusted hazard ratio, .63, 95% confidence interval, .60-.66). Analysis of the 1988-2003 SEER data indicated that extirpation of the primary breast tumor in patients with stage IV disease was associated with a marked reduction in risk of dying after controlling for variables associated with survival.Keywords
This publication has 25 references indexed in Scilit:
- What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?Gynecologic Oncology, 2006
- Complete Excision of Primary Breast Tumor Improves Survival of Patients With Metastatic Breast Cancer at DiagnosisJournal of Clinical Oncology, 2006
- Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary TumorAnnals of Surgical Oncology, 2006
- Facts and Controversies in Systemic Treatment of Metastatic Breast CancerThe Oncologist, 2004
- A Role for Curative Surgery in the Treatment of Selected Patients with Metastatic Breast CancerThe Oncologist, 2003
- Does aggressive local therapy improve survival in metastatic breast cancer?Surgery, 2002
- The effect of residual mass size on response to chemotherapy after surgical cytoreduction for advanced ovarian cancer: Long-term resultsInternational Journal of Gynecologic Cancer, 2002
- Cytoreductive surgery for advanced stages of ovarian cancerSeminars in Surgical Oncology, 2000
- Treatment of Breast CancerThe New England Journal of Medicine, 1998
- Intensive Surgical and Chemotherapeutic Management of Advanced Ovarian CancerSurgical Clinics of North America, 1978