title: Presence of symptoms and timing of surgery do not affect the prognosis of patients with primary metastatic breast cancer.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Máxima Medisch Centrum, Postbus 7777, 5500 MB Veldhoven, The Netherlands. j.ruiterkamp@mmc.nl
authors.forename: J
authors.initials: J
authors.lastname: Ruiterkamp
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: J A
authors.initials: JA
authors.lastname: Roukema
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: V C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.forename: M F
authors.initials: MF
authors.lastname: Ernst
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000379:methods / Q000401:mortality*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009426:Netherlands; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome