title: Association of surgery with improved survival in stage IV breast cancer patients.
abstract: OBJECTIVE
  This study aims to examine the role of surgery in patients with stage IV breast cancer.
  
  
  BACKGROUND
  Historically, women who present with metastatic breast cancer are not offered surgical treatment. However, recent reports indicate that surgery may improve outcome. Using a large database of women whom presented with stage IV breast cancer, we compared outcome of patients who had resection of their primary cancer to those who did not.
  
  
  METHODS
  Of 16,401 patients, 807 had stage IV disease at presentation, and 395 survived >90 days and were included in this analysis. Clinical and tumor characteristics, surgical treatment, and survival were compared for the surgically versus nonsurgically treated patients.
  
  
  RESULTS
  Two hundred and forty-two patients (61.3%) had definitive surgery for their primary tumor and 153 (38.7%) did not. Patients who underwent surgery were significantly older, were more likely to be white, more often had hormone receptor positive disease, had small primary tumors, and had fewer metastatic sites and less visceral involvement. The median survival of surgically treated patients was 27.1 months versus 16.8 months for patients without surgical resection (P < 0.0001). In multivariate analysis, which included surgical treatment, age, race, estrogen and progesterone receptor status, number of metastatic sites, and presence of visceral metastases, surgery remained an independent factor associated with improved survival (P = 0.006).
  
  
  CONCLUSIONS
  Patients with stage IV breast cancer who had definitive surgical treatment of their primary tumors had more favorable disease characteristics. However, after adjustment for these characteristics, surgical treatment remained an independent factor associated with improved survival.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. blanchard722@msn.com
authors.forename: D Kay
authors.initials: DK
authors.lastname: Blanchard
authors.forename: Priya B
authors.initials: PB
authors.lastname: Shetty
authors.forename: Susan G
authors.initials: SG
authors.lastname: Hilsenbeck
authors.forename: Richard M
authors.initials: RM
authors.lastname: Elledge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome