Stage IV breast cancer in the community hospital setting: Primary tumor extirpation effect on overall survival.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 90-90
Author(s):  
J. A. Tjoe ◽  
L. A. Robinson ◽  
J. Stephenson ◽  
J. J. Marx
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Hormonal Therapy ◽  
Primary Tumor ◽  
Community Hospital ◽  
Tumor Resection ◽  
Hospital Setting ◽  
Stage Iv ◽  
Stage Iv Breast Cancer ◽  
Tumor Extirpation

90 Background: Publications from academic centers and national cancer databases suggest a survival advantage for women who undergo primary tumor extirpation in the setting of known distant disease. We asked if similar findings exist in a community hospital setting. Methods: 15,887 patients entered in a longitudinally maintained breast cancer database (encompassing a system network of 13 community hospitals) during 1985-2009 were analyzed for those diagnosed with stage IV disease upon initial presentation. The cohort was divided into those who underwent primary tumor resection, and those who did not. The two subgroups were compared for patient demographics, tumor characteristics, sites of distant metastases, systemic treatment, and overall survival (OS). Results: 643 (4.05%) presented with an intact primary breast malignancy and synchronous distant metastasis. Median age at diagnosis: 66 years (range 22-96). Median OS: 15 months (range 0-249). 264 (41.1%) patients underwent primary tumor resection as part of first course treatment. On Kaplan-Meier univariate analysis, patients who underwent surgical extirpation of the primary tumor demonstrated improved median OS compared to those who did not (26 vs 10 months; p<0.0001, HR 0.52). Age at diagnosis <50 (p=0.0003, HR 0.65) and oligometastasis to bone (p=0.0002, HR 0.72) were statistically significant predictors of improved OS. Race, primary tumor size, and ER status alone did not influence OS. Those ER+ patients who underwent primary tumor excision in addition to chemotherapy and/or hormonal therapy fared significantly better than those treated with systemic therapy alone (32 vs 17 months; p<0.0001). Chemotherapy 16+ weeks prior to surgery improved OS compared to those who had surgery <16 weeks after starting chemotherapy. While there was no difference with regards to type of resection (partial vs simple vs modified radical mastectomy), clear margins were imperative to optimize OS. Conclusions: Patients with stage IV breast cancer treated at community hospitals also demonstrate improved OS after primary tumor extirpation, especially in the context of a multimodality approach combining chemotherapy and/or hormonal therapy preceding surgery.

Effect of primary tumor resection on overall survival in patients with stage IV breast cancer

2019 ◽  
Vol 25 (5) ◽  
pp. 908-915
Author(s):  
Sung Mook Lim ◽  
Jee Ye Kim ◽  
Hyung Seok Park ◽  
Seho Park ◽  
Gun Min Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Stage Iv Breast Cancer

Primary tumor resection in patients with stage IV breast cancer: 10‐year experience

2021 ◽  
Author(s):  
Malke Asaad ◽  
Jennifer A. Yonkus ◽  
Tanya L. Hoskin ◽  
Tina J. Hieken ◽  
James W. Jakub ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Stage Iv Breast Cancer

Impact on overall survival of primary tumor extirpation in breast cancer patients who present with stage IV disease

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 598-598
Author(s):  
J. E. Lang ◽  
R. Rao ◽  
L. Feng ◽  
F. Meric-Bernstam ◽  
I. Bedrosian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Primary Tumor ◽  
Survival Benefit ◽  
Stage Iv ◽  
Breast Cancer Patients ◽  
Stage Iv Breast Cancer ◽  
Stage Iv Disease

598 Background: Limited data exists regarding optimal local therapy for patients who present with stage IV breast cancer with an intact primary tumor. Two retrospective series, from the National Cancer Data Base and the Geneva Cancer Registry, showed that surgery may improve overall survival in these patients. Our institutional experience demonstrated improved metastatic progression-free survival after a median follow-up of 32.1 months but did not show a survival benefit at short term follow-up. We evaluated the impact of local control on overall (OS) and disease-specific survival (DSS) in this population after a longer follow-up interval to determine if a survival benefit could be demonstrated from local surgical treatment for selected patients with stage IV breast cancer. Methods: We reviewed the records of all patients at our institution who presented from 1997–2002 with stage IV disease with an intact primary tumor. OS and DSS were estimated by the Kaplan-Meier method. The log-rank test was used to compare the difference in survival between surgical and non-surgical patients. Multivariate statistical analysis was performed using the Cox proportional hazards model. Results: Of 220 patients identified with stage IV disease with an intact primary tumor, 80 (36%) underwent surgical resection of the primary tumor; 39 (49%) had segmental mastectomy and 41 (51%) had a total mastectomy. There were 140 (64%) patients who did not undergo surgery. The median follow-up duration from time of presentation to our institution was 58.6 months and the median OS time after presentation was 45.8 months. After adjustment for covariates, surgery was associated with improved OS (p=0.03) and DSS (p=0.04) compared to the non-surgical group. Conclusions: With a median follow-up time of 58.6 months, patients who presented with stage IV breast cancer with an intact primary tumor treated surgically had significantly improved OS and DSS compared to patients who did not undergo surgery. Our findings may be limited by a selection bias. Therefore, we feel that the issue of surgical intervention for the primary tumor in stage IV breast cancer patients deserves to be carefully studied in a well-designed, prospective, multi-center trial. No significant financial relationships to disclose.

A randomized controlled trial comparing primary tumor resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (JCOG1017 PRIM-BC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS588-TPS588 ◽  
Author(s):  
Tadahiko Shien ◽  
Tomonori Mizutani ◽  
Kiyo Tanaka ◽  
Takayuki Kinoshita ◽  
Fumikata Hara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Her2 Status ◽  
Free Survival ◽  
Stage Iv Breast Cancer

TPS588 Background: The possibility of improving the survival of stage IV breast cancer patients by primary tumor resection (PTR) has been reported by several retrospective studies; however, these studies essentially suffer from biases such as arbitrary patient selection, diverse timing of surgery or various regimens of systemic therapy. Five prospective randomized trials including our trial have evaluated the efficacy of PTR for them. Two have reported final results, but those results were inconsistent. Therefore, this subject still remains a hotly debated topic at major breast conferences. Methods: Our trial is being conducted to confirm the superiority of PTR plus systemic therapy over systemic therapy alone in stage IV pts who are sensitive to primary systemic therapy (PST) in this study. The inclusion criteria are untreated pts with histologically confirmed invasive breast cancer with one or more measurable distant metastatic lesions diagnosed by radiological examination.All pts receive PST according to the ER and HER2 status of the primary breast cancer after the first registration. After three months, the pts who are sensitive to PST are randomized to the PTR plus systemic therapy arm or the systemic therapy alone arm. After randomization and surgery in the former arm, or after randomization in the latter arm, the same systemic therapies are continued until progression of diseases and next appropriate regimens are started after that. The primary endpoint is the overall survival, and the secondary endpoints are proportion of pts without tumor progression at the metastatic sites, yearly local recurrence-free survival, proportion of local ulcer/local bleeding, yearly primary tumor resection-free survival, adverse events (AEs) of chemotherapy, operative morbidity, and serious AEs. Sample size for randomized pts was determined to attain at least 80% of power to detect a 6 months difference with one-sided alpha of 0.05.The pts accrual was started in May 2011. Enrollment of 410 pts for randomization is planned over a 7-year accrual period. 307 pts have been randomized until Jan 2017. This trial was registered at UMIN-CTR[umin.ac.jp/ctr/] as UMIN000005586. Clinical trial information: UMIN000005586.

Patient and Tumor Characteristics Associated with Primary Tumor Resection in Women with Stage IV Breast Cancer: Analysis of 1988-2003 SEER Data

2008 ◽  
Vol 14 (6) ◽  
pp. 538-542 ◽  
Author(s):  
Jennifer Gnerlich ◽  
Jeffrey M. Dueker ◽  
Donna B. Jeffe ◽  
Anjali D. Deshpande ◽  
Samantha Thompson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Tumor Characteristics ◽  
Stage Iv Breast Cancer ◽  
Seer Data

Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis

2018 ◽  
Vol 44 (10) ◽  
pp. 1504-1512 ◽  
Author(s):  
Weikai Xiao ◽  
Yutian Zou ◽  
Shaoquan Zheng ◽  
Xiaoqian Hu ◽  
Peng Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Primary Tumor ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Stage Iv Breast Cancer
Sign in / Sign up

Export Citation Format

Share Document