Presence of symptoms and timing of surgery do not affect the prognosis of patients with primary metastatic breast cancer.

AIMS: Though most studies on surgical resection of the breast tumor in patients with primary distant metastatic breast cancer (MBC) indicated that surgery is associated with prolonged overall survival, some state that this effect has been confounded by indication and timing of surgery. In this study we analyzed these possible confounders and their relation to overall survival. METHODS: To determine the impact of potential confounders, individual charts of 279 patients with primary MBC were reviewed. RESULTS: The median survival in patients treated with surgery of the breast tumor was 39 months, compared to 15 months for those without surgery (p < 0.0001). The median survival of patients with symptomatic metastatic disease (n = 112) was 19 months, compared to 22 months for those without symptomatic disease (n = 167) (p = 0.15). Patients who received surgery and whose metastases were detected before surgery of the breast tumor had taken place (n = 40) had a median survival of 38 months, compared to 40 months for patients in whom the metastatic disease was diagnosed after surgery (n = 43) (p = 0.81). CONCLUSION: Presence of symptomatic metastatic disease was no significant prognostic factor for patients with distant metastasis at diagnosis, neither was the timing of surgery. It is unlikely that the prolonged survival after surgery is explained by these potentials confounders.

Improved survival of patients with primary distant metastatic breast cancer in the period of 1995-2008. A nationwide population-based study in the Netherlands.

In this study, changes in prognosis for more than 8,000 patients with primary distant metastatic breast cancer were analyzed, using nation-wide data of the Netherlands Cancer Registry. Besides the roll of systemic treatment, the effect of surgery of the primary tumor was evaluated. Between 1995 and 2008, 160,595 new patients were diagnosed with invasive breast cancer. Of these patients, 8,031 (5.0%) had distant metastases at diagnosis. Patients were divided into three periods, based on the year of diagnosis of their disease. The median survival was 1.42 years for patients diagnosed in the period 1995-1999, 1.61 years in the period 2000-2004 and 1.95 years in the period 2005-2008. The improvement of the median survival was most pronounced for patients younger than 50 years. Patients receiving systemic treatment, loco-regional radiotherapy or breast surgery had a significantly lower risk of death compared to patients not receiving these treatments. An improvement of 6 months is observed in the median survival of patients with primary distant metastatic breast cancer between 1995 and 2008. The increased efficacy of chemotherapy and the introduction of targeted treatments are the most likely explanations for this improvement, which was most marked for younger patients.

Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis.

OBJECTIVE: Recent studies indicate that removal of the primary tumour may have a beneficial effect on mortality risk of patients with primary distant metastatic breast cancer (stage IV), although most of them did not rule out confounding by the presence of co-morbidity. In this retrospective study the impact of surgical resection of the primary tumour on the survival of patients with primary distant metastatic disease is investigated, taking into account the presence of co-morbidity and other potential confounders. METHODS: Between 1993 and 2004, 15 769 patients with breast cancer were diagnosed in the south of the Netherlands. This study included the 728 patients with distant metastatic disease at initial presentation, which was 5% of all patients. Of them, 40% had surgery of the primary tumour. Follow-up was carried out until 1 July 2006. RESULTS: Median survival of the patients who had surgery of their primary tumour was significantly longer than for the patients who did not have surgery (31 vs. 14 months). The 5-year survival rates were 24.5% and 13.1%, respectively (p < 0.0001). In a multivariable Cox regression analysis, adjusting for age, period of diagnosis, T-classification, number of metastatic sites, co-morbidity, use of loco-regional radiotherapy and use of systemic therapy, surgery appeared to be an independent prognostic factor for overall survival (HR = 0.62; 95% CI 0.51-0.76). CONCLUSION: Removal of the primary tumour in patients with primary distant metastatic disease was associated with a reduction of the mortality risk of around 40%. The association was independent of age, presence of co-morbidity and other potential confounders, but a randomized controlled trial will be needed to rule out residual confounding.