Effects of surgical excision on survival of patients with stage IV breast cancer.
BACKGROUND
Non-palliative resection of the primary tumor in stage IV breast cancer is controversial. Our aim was to determine whether surgery improves survival in stage IV patients.


METHODS
We reviewed records of all stage IV breast cancer patients (1990-2000) at our institution. Data collection included demographics, metastasis sites, treatment, and survival. Survival was compared between metastasis type, hormonal therapy versus no hormonal therapy, chemotherapy versus no chemotherapy, radiation versus no radiation, and surgery versus no surgery. To ascertain local therapy effects while accounting for chemotherapy, we analyzed survival among chemotherapy alone versus chemotherapy with radiation versus chemotherapy with surgery. We also performed multivariate analysis by multiple linear regression.


RESULTS
Of 157 patients, 58 (37%) had bone-only metastases, 99 (63%) had visceral metastases. Both groups had a 17-mo median survival. Eighty (51%) received hormonal therapy while 77 (49%) did not. Both groups had a 15-mo median survival. Eighty-four (54%) received chemotherapy with a 25-mo median survival versus 8 mo for 73 (46%) not receiving chemotherapy, Wilcoxon (P < 0.0001), and log-rank (P = 0.02). Fifty-eight (37%) received radiation and 99 (63%) did not, with both groups having a 17-mo median survival. Fifty-two (33%) with surgery to the breast primary had a 25-mo median survival, while 105 (67%) without surgery had a 13-mo median survival, Wilcoxon (P = 0.004) and log-rank (P = 0.06). Among patients receiving chemotherapy, 37 with chemotherapy alone had a 21-mo median survival versus 40 mo for the 14 with chemotherapy and radiation and 22 mo for the 33 with chemotherapy and surgery. These differences were not significant by Wilcoxon (P = 0.41) or log-rank (P = 0.36). Multivariate analysis determined chemotherapy as the only factor associated with improved survival (P = 0.02).


CONCLUSIONS
Our data, when standardized for chemotherapy, suggests loco-regional therapy does not improve survival.
Department of Surgery, Massey Cancer Center, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia 23298-0568, USA. hnvu@vcu.edu
Anna M
AM
Leung
Huan N
HN
Vu
Kim-Anh
KA
Nguyen
Leroy R
LR
Thacker
Harry D
HD
Bear
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014768:Virginia / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal