title: Impact of Primary Tumor Surgery in Stage IV Male Breast Cancer.
abstract: Primary tumor surgery (PTS) is not a standard treatment modality in stage IV breast cancer. Retrospective studies in female breast cancer show improved survival in women undergoing PTS; however, data regarding the impact of surgery in male breast cancer are lacking. The objective of this study was to analyze the impact of PTS on survival among men with metastatic breast cancer.
  
  
  
  A retrospective study was conducted of men diagnosed with metastatic breast cancer at diagnosis were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2011. Cox proportional hazards regression models were used to compare the differences in survival in men who did and did not undergo PTS.
  
  
  
  A total of 439 men with stage IV breast cancer at diagnosis were identified, of which 222 (51%) underwent PTS, 171 (77%) mastectomy, and 51 (23%) partial mastectomy. The median age was 65 years; 74% of participants were white, 51% had tumors ≤ T2, 65% had estrogen receptor (ER)-positive tumor, and 24% had unknown ER status. Univariate analysis between the surgery and no-surgery arms showed that white race (P = .04), lower T stage and grade (P = .0003, P = .004), ER positivity (P = .0002), and later year of diagnosis (P < .0001) were associated with better survival. PTS was associated with improvement in median overall survival (29 vs. 11 months, P < .0001). On Cox regression analysis, ER negativity (hazard ratio = 2.08; 95% confidence interval, 1.41-3.01; P < .0003) and not undergoing PTS were associated with diminished survival (hazard ratio = 1.81; 95% confidence interval, 1.42-2.31; P < .0001).
  
  
  
  PTS among men with metastatic breast cancer was associated with improved survival in this retrospective analysis.
authors.affiliation: Division of Hematology Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC. Electronic address: muzaffarm@ecu.edu.
authors.forename: Mahvish
authors.initials: M
authors.lastname: Muzaffar
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Kachare
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
authors.forename: Nasreen
authors.initials: N
authors.lastname: Vohra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D018567:Breast Neoplasms, Male / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Metastatic breast cancer; Primary tumor surgery; Stage IV cancer; Survival