title: Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer.
abstract: BACKGROUND
  Among women presenting with de novo stage IV breast cancer, 35% to 60% undergo local therapy, presumably to avoid uncontrolled chest wall disease. Several studies suggest that resection of the primary tumor may prolong survival, but chest wall outcome data are notably lacking. The authors reviewed chest wall status, time to first progression (TTFP), and overall survival (OS) in this group of women.
  
  
  METHODS
  Women presenting at the Lynn Sage Breast Center (1995-2005) with an intact primary tumor and stage IV breast cancer or postoperative diagnosis of distant metastases were identified. Logistic regression and Cox proportional hazards models, adjusted for relevant covariates, were used to examine associations between surgical treatment and chest wall status, TTFP, and OS.
  
  
  RESULTS
  Of 111 eligible women, 47 (42%) underwent early resection of the primary tumor. Chest wall status was available for 103 women. Local control was maintained in 36 of 44 (82%) patients in the surgical group versus 20 of 59 (34%) patients without surgery (P = .001). TTFP was prolonged in the surgical group (adjusted hazards ratio [HR], 0.493; P = .015). The adjusted HR for OS in the surgical group was 0.798 (P = .520). Chest wall control was associated with improved OS regardless of whether surgical resection of the tumor was performed (HR, 0.415; P < .0002).
  
  
  CONCLUSIONS
  These data support the notion that improved local control may play a role in improving outcomes in women with stage IV breast cancer, and resection of in-breast tumors can help to achieve this. A randomized trial is needed to rule out selection bias as an explanation for these findings.
authors.affiliation: Lynn Sage Comprehensive Breast Center, Chicago, Illinois, USA.
authors.forename: Hannah W
authors.initials: HW
authors.lastname: Hazard
authors.forename: Seema R
authors.initials: SR
authors.lastname: Gorla
authors.forename: Denise
authors.initials: D
authors.lastname: Scholtens
authors.forename: Krystyna
authors.initials: K
authors.lastname: Kiel
authors.forename: William J
authors.initials: WJ
authors.lastname: Gradishar
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D035441:Thoracic Wall / Q000473:pathology*