title: Impact of breast surgery on survival in women presenting with metastatic breast cancer.
abstract: BACKGROUND
  Advanced breast cancer is common in less affluent parts of Asia. The impact of breast surgery on survival of women presenting with metastatic breast cancer in this setting was investigated.
  
  
  METHODS
  Women presenting with metastatic breast cancer at the initial diagnosis at the University Malaya Medical Centre (Malaysia) between 1993 and 2008 were included in the study. Mortality of patients who had primary breast surgery was compared with that of those without surgery, and adjusted for possible confounders by means of a propensity score.
  
  
  RESULTS
  Of 3689 patients, 375 (10·2 per cent) presented with metastatic disease. One hundred and thirty-nine patients (37·1 per cent) underwent surgery. A total of 330 deaths occurred during 6814 person-months of follow-up. The 2-year survival rate was 21·2 (95 per cent confidence interval (c.i.) 15·9 to 26·5) per cent in women who did not have surgery and 46·3 (37·7 to 54·9) per cent in those who had breast surgery. Breast surgery was associated with a 28 per cent lower risk of death (hazard ratio 0·72, 95 per cent c.i. 0·56 to 0·94), after adjustment for patient and tumour characteristics, metastatic profile and treatment.
  
  
  CONCLUSIONS
  Surgical resection of the primary breast tumour was independently associated with a survival advantage in patients presenting with metastatic breast cancer.
authors.affiliation: Julius Centre University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: N Bhoo
authors.initials: NB
authors.lastname: Pathy
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: N A
authors.initials: NA
authors.lastname: Taib
authors.forename: M
authors.initials: M
authors.lastname: Hartman
authors.forename: C H
authors.initials: CH
authors.lastname: Yip
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008408:Mastectomy / Q000401:mortality; D008875:Middle Aged; D057216:Propensity Score; D016019:Survival Analysis
chemical_list: D018931:Antineoplastic Agents, Hormonal