title: Local Resection of Primary Tumor in Upfront Stage IV Breast Cancer.
abstract: BACKGROUND
  This study aimed to identify the association of local surgery of the primary tumor in metastatic breast cancer (MBC) patients with overall survival (OS) and prognostic factors.
  
  
  METHODS
  Patients with primary MBC (1990-2006) were included in our retrospective analysis (n = 236). 83.1% had surgery for the primary tumor. OS was evaluated using Kaplan-Meier estimates. Predictive factors for OS were determined.
  
  
  RESULTS
  Median follow-up was 123 months for all patients still alive at the time of analysis. In univariate analysis, patients with surgery of the primary tumor had significantly prolonged OS (28.9 vs. 23.9 months). Within the surgery group, patients with MBC limited to 1 organ system had a better outcome (39.3 vs. 24.9 months), as did asymptomatic patients. Independent risk factors for shorter OS were hormone receptor negativity, symptoms, and involvement of ≥ 1 organ system.
  
  
  CONCLUSIONS
  Patient selection for local therapy was confounded by a more favorable profile and a lesser tumor burden before surgery, which might implicate a bias. Nevertheless, our univariate results indicate that local surgery of the primary tumor in MBC patients could be considered as part of the therapeutic regimen in selected patients. However, larger patient numbers are needed to prove these findings in the multivariate model.
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kolben
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Kolben
authors.affiliation: Klinikum Dritter Orden, Department for Obstetrics and Gynecology, Munich, Germany, Munich, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Himsl
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Degenhardt
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Cancer Center (MCC), Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilian University, Munich, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wuerstlein
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilian University, Munich, Germany, Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kahlert
keywords: Local resection; Metastatic breast cancer; Stage IV breast cancer