Clinical Research Papers:
Hormone receptor status may impact the survival benefit of surgery in stage IV breast cancer: a population-based study
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Yinuo Tan1,2,*, Xiaofen Li2,*, Haiyan Chen1,2, Yeting Hu1,2, Mengjie Jiang2,3, Jianfei Fu4, Ying Yuan2,3 and Kefeng Ding1,2
1 Department of Surgical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
2 Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Hangzhou, Zhejiang Province, China, and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
3 Department of Medical Oncology, 2nd Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
4 Department of Oncology, Jinhua Central Hospital, Jinhua, P.R. China
* These authors have contributed equally to this work
Kefeng Ding, email:
Ying Yuan, email:
Keywords: metastatic breast cancer, surgery, prognosis, SEER
Received: November 13, 2015 Accepted: May 29, 2016 Published: August 11, 2016
Introduction: The role of surgery in stage IV breast cancer is controversial. We used the Surveillance, Epidemiology, and End Results database to explore the impact of surgery on the survival of patients with stage IV breast cancer.
Methods: In total, 10,441 eligible stage IV breast cancer patients from 2004 to 2008 were included. They were divided into four groups as follows: R0 group (patients who underwent primary site and distant metastatic site resection), primary site resection group, metastases resection group, and no resection group.
Results: The four groups achieved a median survival time (MST) of 51, 43, 31 and 21 months, respectively, P < 0.001. The Cox proportional hazards model showed that the R0 group, primary resection group and metastases resection group had a good survival benefit, with hazard ratios of 0.558 (95% CI, 0.471-0.661), 0.566 (95% CI, 0.557-0.625) and 0.782 (95% CI, 0.693-0.883), respectively. In the hormone receptor (HR)-positive population, the R0 group (MST = 66 m, 5-year OS = 54.1%) gained an additional survival benefit compared with the primary resection group (MST = 52 m; 5-year OS = 44.9%; P < 0.001). The metastases resection group (MST = 38 m; 5-year OS = 31.7%) survived longer than the no resection group (MST = 28 m; 5-year OS = 22.0%; P < 0.001). In the HR-negative population, the R0 group and primary resection group had a similar survival (P = 0.691), and the metastases resection group had a similar outcome to that of the no resection group (P = 0.526).
Conclusion: Patients who underwent surgery for stage IV breast cancer showed better overall survival than the no resection group. Cytoreductive surgery could provide a survival benefit in HR+ stage IV breast cancer; however, in the HR- population, extreme caution should be exercised when considering surgery.
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