title: Is there a role for locoregional surgery in stage IV breast cancer?
abstract: Current guidelines do not recommend locoregional surgery for Stage IV breast cancer at presentation despite some studies suggesting a survival benefit. We aimed to assess outcomes in patients with Stage IV breast cancer who underwent surgery. In a cohort study of all Stage IV breast cancers diagnosed at our tertiary-referral specialist centre between 2006 and 2012, we assessed patient survival in the context of demographics, histopathology, metastatic burden, and type of surgery performed. One hundred and nine patients were included; 52 underwent surgery. Patients in the surgery group had longer 5-year-survival (p = 0.003). Survival was also significantly longer in those with just one site of metastatic disease (p < 0.001). Patients with axillary cytology positive for regional metastases were less likely to proceed to surgery. Locoregional surgery does confer a survival advantage in Stage IV breast cancer. Assessment of preoperative axillary cytology may preclude some patients from proceeding to potentially beneficial locoregional surgery.
authors.affiliation: Breastcheck Western Unit, Newcastle Road, Galway, Ireland. Electronic address: edelquinn@rcsi.ie.
authors.forename: Edel M
authors.initials: EM
authors.lastname: Quinn
authors.affiliation: Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kealy
authors.affiliation: Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Meara
authors.affiliation: Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Whelan
authors.affiliation: Department of Radiology, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ennis
authors.affiliation: Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Malone
authors.affiliation: Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland.
authors.forename: Ray
authors.initials: R
authors.lastname: McLaughlin
authors.affiliation: Division of Surgery, National University of Ireland Galway, University Road, Galway, Ireland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kerin
authors.affiliation: Breastcheck Western Unit, Newcastle Road, Galway, Ireland.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Sweeney
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis
keywords: Axillary fine needle aspiration cytology; Breast surgery; Metastatic breast cancer; Stage IV breast cancer