Effect of surgical treatment on survival in patients with stage <b>Ⅳ</b> breast cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Shikun , HU Chanchan , XU Zhuangyu , XIAO Shuoyang ,  LI Qingshan

Department of Oncology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P. R. China;

Corresponding author：

LI Qingshan, Email: libing200865@126.com

Keywords：

stage Ⅳ breast cancer; surgical tretment; meta-analysis

DOI：

10.7507/1007-9424.201908083

Video：

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Objective To investigate effect of resection of primary tumors on overall survival in patients with stage Ⅳ breast cancer.Methods The related literatures on the treatment of stage Ⅳ breast cancer in the PubMed, Medline, Cochrane Library, Embase, CNKI, Wanfang Data, CBM, VIP, etc. were comprehensively searched. Two authors independently screened the literatures and extracted data, including the overall survival, progression-free survival and tumor characteristics. The meta analysis was performed using RevMan 5.3 software and SPSS 21.0.Results A total of 21 articles were included in this study, including 17 retrospective cohort studies and 4 randomized controlled studies. A total of 5 250 patients with stage Ⅳ breast cancer were included, of which 2 686 patients underwent the local tumor resection+systemic therapy (operation group) and 2 564 patients only received the systemic therapy (non-operation group). The results of meta-analysis showed that the overall survival of the operation group was significantly better than that of the non-operation group [HR=0.64, 95%CI (0.59, 0.69), P<0.000 01], the result of subgroup analysis in the retrospective cohort studies [HR=0.60, 95%CI (0.55, 0.65), P<0.000 01] was consistent with this. However the disease-free survival had no statistical significance [HR=0.43, 95%CI (0.17, 1.11), P=0.08]. The clinicopathologic features of the two groups were further analyzed showed that the patients in the operation group were younger (P<0.05), and the proportions of the patients with T2 stage or below, bone metastasis, ER negative, radiotherapy, or metastatic lymph nodes less than 3 were higher (P<0.05) as compared with the non-operation group.Conclusions Local resection of primary tumors in patients with stage Ⅳ breast cancer can improve overall survival. Individualized treatment should be carried out.

Citation： GUO Shikun, HU Chanchan, XU Zhuangyu, XIAO Shuoyang, LI Qingshan. Effect of surgical treatment on survival in patients with stage Ⅳ breast cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 588-594. doi: 10.7507/1007-9424.201908083 Copy

1.	Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review. Bethesda: National Cancer Institute, 1975-2008. http://seer.cancer.gov/csr/1975_2008/.
2.	Bevers TB, Helvie M, Bonaccio E, et al. Breast cancer screening and diagnosis, Version 3. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(11): 1362-1389.
3.	Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol, 2006, 13(3): 413-424.
4.	Xiong Z, Deng G, Wang J, et al. Could local surgery improve survival in de novo stage Ⅳ breast cancer? BMC Cancer, 2018, 18(1): 885.
5.	Xie Y, Lv X, Luo C, et al. Surgery of the primary tumor improves survival in women with stage Ⅳ breast cancer in Southwest China: A retrospective analysis. Medicine (Baltimore), 2017, 96(22): e7048.
6.	Ruiterkamp J, Ernst MF, van de Poll-Franse LV, et al. Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol, 2009, 35(11): 1146-1151.
7.	Rhu J, Lee SK, Kil WH, et al. Surgery of primary tumour has survival benefit in metastatic breast cancer with single-organ metastasis, especially bone. ANZ J Surg, 2015, 85(4): 240-244.
8.	Rashaan ZM, Bastiaannet E, Portielje JE, et al. Surgery in metastatic breast cancer: patients with a favorable profile seem to have the most benefit from surgery. Eur J Surg Oncol, 2012, 38(1): 52-56.
9.	Rapiti, Verkooijen HM, Vlastos G, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol, 2006, 24(18): 2743-2749.
10.	Pérez-Fidalgo JA, Pimentel P, Caballero A, et al. Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast, 2011, 20(6): 548-554.
11.	Neuman HB, Morrogh M, Gonen M, et al. Stage Ⅳ breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer, 2010, 116(5): 1226-1233.
12.	Lang JE, Tereffe W, Mitchell MP, et al. Primary tumor extirpation inbreast cancer patients who present with stage Ⅳ disease is associated with improved survival. Ann Surg Oncol, 2013, 20(6): 1893-1899.
13.	Kolben T, Kolben TM, Himsl I, et al. Local resection of primary tumor in upfront stage Ⅳ breast cancer. Breast Care (Basel), 2016, 11(6): 411-417.
14.	Hazard HW, Gorla SR, Scholtens D, et al. Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer, 2008, 113(8): 2011-2019.
15.	Fields RC, Jeffe DB, Trinkaus K, et al. Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage Ⅳ breast cancer after controlling for site of metastasis. Ann Surg Oncol, 2007, 14(12): 3345-3351.
16.	Pathy NB, Verkooijen HM, Taib NA, et al. Impact of breast surgery on survival in women presenting with metastatic breast cancer. Br J Surg, 2011, 98(11): 1566-1572.
17.	Blanchard DK, Shetty PB, Hilsenbeck SG, et al. Association of surgery with improved survival in stage Ⅳ breast cancer patients. Ann Surg, 2008, 247(5): 732-738.
18.	Bafford AC, Burstein HJ, Barkley CR, et al. Breast surgery in stage Ⅳ breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat, 2009, 115(1): 7-12.
19.	Babiera GV, 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, 2006, 13(6): 776-782.
20.	Akay CL, Ueno NT, Chisholm GB, et al. Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage Ⅳ inflammatory breast cancer. Cancer, 2014, 120(9): 1319-1328.
21.	Soran A, Ozbas S, Kelsey SF, et al. Randomized trial comparing locoregional resection of primary tumor with no surgery in stage Ⅳ breast cancer at the presentation (Protocol MF07-01): a study of Turkish Federation of the National Societies for Breast Diseases. Breast J, 2009, 15(4): 399-403.
22.	King TA, Lyman JP, Gonen M, et al. A prospective analysis of surgery and survival in stage Ⅳ breast caner (TBCRC 013). Translational Breast Cancer Research Consortium: 2016 ASCO Annual Meeting, 2016.
23.	Fitzal F, Bjelic-Radisic V, Knauer M, et al. Impact of breast surgery in primary metastasized breast cancer: outcomes of the prospective randomized phase Ⅲ ABCSG-28 POSYTIVE Trial. Ann Surg, 2019, 269(6): 1163-1169.
24.	Badwe R, Hawaldar R, Nair N, et al. Locoregional treatment versus notreatment of the primary tumour in metastatic breast cancer: an open-labelrandomised controlled trial. Lancet Oncol, 2015, 16(13): 1380-1388.
25.	Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma duringthe platinum era: a meta-analysis. J Clin Oncol, 2002, 20(5): 1248-1259.
26.	Harris E, Barry M, Kell MR. Meta-analysis to determine if surgical resection of the primary tumour in the setting of stage Ⅳ breast cancer impacts on survival. Ann Surg Oncol, 2013, 20(9): 2828-2834.
27.	Lim S, Muhs BE, Marcus SG, et al. Results following resection for stage Ⅳ gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol, 2007, 95(2): 118-122.
28.	Kim MY, Oskarsson T, Acharyya S, et al. Tumor self-seeding by circulating cancer cells. Cell, 2009, 139(7): 1315-1326.
29.	Khan SA, DesJardin ESM. Readdressing the role of surgery of the primary tumor in de novo stage Ⅳ breast cancer. Cancer Treat Res, 2018, 173: 73-88.

1. Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review. Bethesda: National Cancer Institute, 1975-2008. http://seer.cancer.gov/csr/1975_2008/.
2. Bevers TB, Helvie M, Bonaccio E, et al. Breast cancer screening and diagnosis, Version 3. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(11): 1362-1389.
3. Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol, 2006, 13(3): 413-424.
4. Xiong Z, Deng G, Wang J, et al. Could local surgery improve survival in de novo stage Ⅳ breast cancer? BMC Cancer, 2018, 18(1): 885.
5. Xie Y, Lv X, Luo C, et al. Surgery of the primary tumor improves survival in women with stage Ⅳ breast cancer in Southwest China: A retrospective analysis. Medicine (Baltimore), 2017, 96(22): e7048.
6. Ruiterkamp J, Ernst MF, van de Poll-Franse LV, et al. Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol, 2009, 35(11): 1146-1151.
7. Rhu J, Lee SK, Kil WH, et al. Surgery of primary tumour has survival benefit in metastatic breast cancer with single-organ metastasis, especially bone. ANZ J Surg, 2015, 85(4): 240-244.
8. Rashaan ZM, Bastiaannet E, Portielje JE, et al. Surgery in metastatic breast cancer: patients with a favorable profile seem to have the most benefit from surgery. Eur J Surg Oncol, 2012, 38(1): 52-56.
9. Rapiti, Verkooijen HM, Vlastos G, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol, 2006, 24(18): 2743-2749.
10. Pérez-Fidalgo JA, Pimentel P, Caballero A, et al. Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast, 2011, 20(6): 548-554.
11. Neuman HB, Morrogh M, Gonen M, et al. Stage Ⅳ breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer, 2010, 116(5): 1226-1233.
12. Lang JE, Tereffe W, Mitchell MP, et al. Primary tumor extirpation inbreast cancer patients who present with stage Ⅳ disease is associated with improved survival. Ann Surg Oncol, 2013, 20(6): 1893-1899.
13. Kolben T, Kolben TM, Himsl I, et al. Local resection of primary tumor in upfront stage Ⅳ breast cancer. Breast Care (Basel), 2016, 11(6): 411-417.
14. Hazard HW, Gorla SR, Scholtens D, et al. Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer, 2008, 113(8): 2011-2019.
15. Fields RC, Jeffe DB, Trinkaus K, et al. Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage Ⅳ breast cancer after controlling for site of metastasis. Ann Surg Oncol, 2007, 14(12): 3345-3351.
16. Pathy NB, Verkooijen HM, Taib NA, et al. Impact of breast surgery on survival in women presenting with metastatic breast cancer. Br J Surg, 2011, 98(11): 1566-1572.
17. Blanchard DK, Shetty PB, Hilsenbeck SG, et al. Association of surgery with improved survival in stage Ⅳ breast cancer patients. Ann Surg, 2008, 247(5): 732-738.
18. Bafford AC, Burstein HJ, Barkley CR, et al. Breast surgery in stage Ⅳ breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat, 2009, 115(1): 7-12.
19. Babiera GV, 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, 2006, 13(6): 776-782.
20. Akay CL, Ueno NT, Chisholm GB, et al. Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage Ⅳ inflammatory breast cancer. Cancer, 2014, 120(9): 1319-1328.
21. Soran A, Ozbas S, Kelsey SF, et al. Randomized trial comparing locoregional resection of primary tumor with no surgery in stage Ⅳ breast cancer at the presentation (Protocol MF07-01): a study of Turkish Federation of the National Societies for Breast Diseases. Breast J, 2009, 15(4): 399-403.
22. King TA, Lyman JP, Gonen M, et al. A prospective analysis of surgery and survival in stage Ⅳ breast caner (TBCRC 013). Translational Breast Cancer Research Consortium: 2016 ASCO Annual Meeting, 2016.
23. Fitzal F, Bjelic-Radisic V, Knauer M, et al. Impact of breast surgery in primary metastasized breast cancer: outcomes of the prospective randomized phase Ⅲ ABCSG-28 POSYTIVE Trial. Ann Surg, 2019, 269(6): 1163-1169.
24. Badwe R, Hawaldar R, Nair N, et al. Locoregional treatment versus notreatment of the primary tumour in metastatic breast cancer: an open-labelrandomised controlled trial. Lancet Oncol, 2015, 16(13): 1380-1388.
25. Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma duringthe platinum era: a meta-analysis. J Clin Oncol, 2002, 20(5): 1248-1259.
26. Harris E, Barry M, Kell MR. Meta-analysis to determine if surgical resection of the primary tumour in the setting of stage Ⅳ breast cancer impacts on survival. Ann Surg Oncol, 2013, 20(9): 2828-2834.
27. Lim S, Muhs BE, Marcus SG, et al. Results following resection for stage Ⅳ gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol, 2007, 95(2): 118-122.
28. Kim MY, Oskarsson T, Acharyya S, et al. Tumor self-seeding by circulating cancer cells. Cell, 2009, 139(7): 1315-1326.
29. Khan SA, DesJardin ESM. Readdressing the role of surgery of the primary tumor in de novo stage Ⅳ breast cancer. Cancer Treat Res, 2018, 173: 73-88.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of surgical treatment on survival in patients with stage Ⅳ breast cancer: a meta-analysis

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