title: Primary tumor extirpation in breast cancer patients who present with stage IV disease is associated with improved survival.
abstract: OBJECTIVE
  Previous evaluation of our institutional experience with stage IV breast cancer patients with an intact primary tumor (IPT) did not reveal an overall survival (OS) benefit for surgery at 32.1 months median follow-up. We assessed the impact of surgery after 74.2 months median follow-up, and the effect of systemic therapy and local radiotherapy (RT).
  
  
  METHODS
  We reviewed the records of all patients presenting from 1997 to 2002 with stage IV disease with an IPT. Cox proportional hazards modeling was used to assess differences in survival between treatment groups.
  
  
  RESULTS
  Seventy-four (35.6 %) of 208 patients underwent resection of the IPT. After adjustment for covariates, surgery was associated with improved OS (p = 0.04). Multivariable analysis revealed that estrogen receptor (ER) positivity (p = 0.002) and having only a single focus of metastatic disease (p = 0.05) were also associated with improved OS. Surgery was highly associated with receipt of RT (p = 0.0003). RT was significantly associated with improved survival (p = 0.015) in an exploratory analysis.
  
  
  CONCLUSIONS
  Stage IV breast cancer patients with an IPT treated surgically had significantly improved OS. Radiation to the primary was also associated with improved survival, but this was evident only with adjustment for the effect of surgery. These findings may be limited by selection bias. Completion of ongoing prospective randomized trials is needed to conclusively determine whether stage IV patients with an IPT should be offered aggressive locoregional therapy.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Lang
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Mitchell
authors.forename: Roshni
authors.initials: R
authors.lastname: Rao
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen