Prognostic implications of lymph node metastasis in advanced ovarian cancer: Analysis of the National Cancer Database 2006 to 2014.

e17042 Background: During debulking surgery (Surg) for advanced ovarian cancer (OvCa), lymph node (LN) sampling is not routinely performed. Hence, prognostic implications of LN involvement following debulking surg and chemotherapy (ChemoRx) were analyzed from the National Cancer Database (NCDB). Methods: Only Stage III and IV patients (pts) from NCDB 2006–2014 undergoing debulking surg and ChemoRx were included. Group A: pts with debulking surg without bowel resection; Group B: pts with major bowel resection and Group C: pts with bowel and bladder resection. Pts were further subdivided according to the use of 1) NeoAdjuvant (NeoAdj) 2) Adjuvant (Adj) and 3) NeoAdj and Adj ChemoRx. Survival analysis was done based on -ve or +ve LN status. Pearson Chi Square testing was used to evaluate the survival between -ve and +ve LN pts. Results: A total of 13839 Pts were included. There were 5757 Pts (41.59%) with -ve LN status, versus 8082 Pts (68.4%) with +ve LN status. Out of 10,737 Stage III and 3,102 Stage IV pts, there were 6,828 in Group A, 6,413 in Group B and 598 in Group C pts. For all patients in Groups A, B, and C, the 5 yr overall survival was better in LN -ve than LN +ve pts. The overall survival for both LN -ve and LN +ve pts was better in Adjuvant chemoRx in all 3 groups, except for Stage III Group C LN-ve pts, where NeoAdj was better (75% vs 37.5%). Overall survival was also slightly better in Stage III vs Stage IV pts. (Table-1). Conclusions: Even though LN dissection is not routinely done during debulking surgery, overall pts with LN metastasis do worse than LN -ve pts irrespective of the timing of ChemoRx. Hence, LN sampling during debulking surg should be strongly considered, as it may provide important prognostic information. Table-1: 5 yr Survival by LN status [Table: see text]

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Prognostic implications of lymph node metastasis in advanced ovarian cancer: Analysis of National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.5567 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 5567-5567

Author(s):

Sukamal Saha ◽

Sabarina Ramanathan ◽

Suresh Mukkamala ◽

Hayman S. Salib ◽

Rajen Oza ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Bowel Resection ◽

Advanced Ovarian Cancer ◽

Stage Iv ◽

Stage Iii ◽

National Cancer Database ◽

Group A ◽

Prognostic Implications ◽

Group B

5567 Background: During debulking surgery (Surg) for advanced ovarian cancer (OvCa), lymph node (LN) sampling are not routinely performed. Hence, prognostic implications of LN involvement following debulking surg and chemotherapy (ChemoRx) were analyzed from National Cancer Database (NCDB). Methods: Only Stage III and Stage IV patients (pts) from 2004 –2014 NCDB pts undergoing Debulking surg. and ChemoRx were included. Group A included pts with debulking surg without bowel resection; Group B with major bowel resection and Group C with bowel and bladder resection. Pts were further subdivided according to the use of 1) NeoAdjuvant (NeoAdj) 2) Adjuvant (Adj) and 3) Neo Adj and Adj ChemoRx. Survival analysis was done based on -ve or +ve LN status. using Pearson Chi Square testing. Results: Out of 10,737 Stage III and 3,102 Stage IV pts, there were 6828 Group A, 6413 Group B and 598 Group C pts. Five year overall survival (OS) for all pts in Stage III with LN-ve vs LN +ve was 59.9% vs 53.9% and Stage IV was 48.7% vs 41.2%. In Group A, B, and C, the 5 yr OS was better in LN – ve than LN +ve pts (Table1). The OS for both LN –ve and LN +ve groups were better in Adjuvant chemoRx in all 3 groups. OS was slightly better in Stage III vs Stage IV pts. Conclusions: Even though LN dissection are not routinely done during debulking surg, overall pts with LN metastasis do worse than LN –ve pts irrespective of the timing of ChemoRx. Hence, LN sampling during debulking surg should be strongly considered as it may provide important prognostic information. [Table: see text]

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Clinical benefits of sequential administration of docetaxel and intermittent erlotinib as a second-line therapy for advanced non-small cell lung cancer (NSCLC): A phase II randomized study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18049 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18049-e18049

Author(s):

Francisco Aparisi ◽

Alfredo Sanchez-Hernandez ◽

Vicente Giner ◽

José Muñoz-Langa ◽

Gaspar Esquerdo ◽

...

Keyword(s):

Overall Survival ◽

Phase Ii ◽

Advanced Nsclc ◽

Randomized Study ◽

Stage Iv ◽

Primary Objective ◽

P Value ◽

Sequential Administration ◽

Group A ◽

Group B

e18049 Background: Patients (p) with advanced NSCLC have few treatment options after progressing to 1st-line platinum doublet chemotherapy. Several preclinical and phase I studies have suggested that sequential administration of erlotinib (E) and docetaxel could avoid possible negative interactions and optimize the benefit obtained against NSCLC. This randomized phase II was designed to address the clinical benefit obtained with the use of sequential administration of docetaxel and intermittent E. Methods: 70 p with advanced NSCLC progressing to previous PDC for advanced disease were randomized (1:1): Group A (n = 34): Docetaxel 75 mg/m2 day 1 and intermittent E (day 2-16), up to 4 cycles, followed by E in monotherapy; and Group B (n = 36): E in monotherapy. Treatment was administered until unacceptable toxicity or disease progression. Primary endpoint: rate of p free of progression at 6 months; secondary endpoints: progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and safety. The study has completed enrolment. At the date of cut-off for this communication, data of 60 patients were available: 30 in Group A/30 in Group B. Results: Baseline characteristics: non-adenocarcinoma (60.3%), current/former smokers (95%), male (90%) and stage IV (87.9%). 6 months PFS: 13.5% in the sequential arm. PFS: 2.7 months (m) in Group A (95% CI 2.1 – 3.8) and 2 m in Group B (95% CI 1.7 – 2.4) p value 0.08. Median OS: 11.0 m (95% CI 4.5 – 13.4) in group A and 4.7m (95% CI 2.5 – 6.6) in Group B with a p value 0.02. DCR: 44.4% in the experimental group whereas in the E one was 30.8%. Adverse events (AEs), including skin rash and diarrhea, were all generally tolerable. Of interest, the low number of p developing neutropenia in the D + E arm. Conclusions: Although the primary objective has not been met, an encouraging benefit on survival has been shown in the exploratory analysis, with a median overall survival of 11 months for patients treated with the sequential regimen (p value 0.02). Final data will be presented during the meeting.

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The Role of HE4, a Novel Biomarker, in Predicting Optimal Cytoreduction After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000944 ◽

2017 ◽

Vol 27 (4) ◽

pp. 696-702 ◽

Cited By ~ 7

Author(s):

Francesco Plotti ◽

Giuseppe Scaletta ◽

Stella Capriglione ◽

Roberto Montera ◽

Daniela Luvero ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Advanced Ovarian Cancer ◽

Debulking Surgery ◽

Gynecology And Obstetrics ◽

Group A ◽

Group B

ObjectivesThis study aimed to evaluate serum human epididymis protein 4 (HE4) changes during neoadjuvant chemotherapy (NACT) to establish HE4 predebulking surgery cutoff values and to demonstrate that CA125, HE4, and computed tomography (CT) taken together are better able to predict complete cytoreduction after NACT in advanced ovarian cancer patients.MethodsFrom January 2006 to November 2015, patients affected by epithelial advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III–IV), considered not optimally resectable, were included in this prospective study. After 3 cycles of NACT, all patients underwent debulking surgery and were allocated, according to residual tumor (RT), into group A (RT = 0) and group B (RT > 0). Serum CA125, HE4, and CT images were recorded during NACT and compared singularly and with each other in term of accuracy, sensitivity, specificity, and positive and negative predictive value.ResultsA total of 94 and 20 patients were included in group A and group B, respectively. The HE4 values recorded before debulking surgery correlated with RT. The identified HE4 cutoff value of 226 pmol/L after NACT was able to classify patients at high or low risk of suboptimal surgery, with a sensitivity of 75% and a specificity of 85% (positive predictive value, 0.87; negative predictive value, 0.70). The combination of CA125, HE4, and CT imaging resulted in the best combination with a sensitivity of 96% and a specificity of 92% (positive predictive value, 0.96; negative predictive value, 0.94).ConclusionsThe novel biomarker HE4, in addition to CA125 and CT, is better able to predict the RT at debulking surgery and the prognosis of patients.

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Minimal Macroscopic Residual Disease (0.1–1 cm). Is It Still a Surgical Goal in Advanced Ovarian Cancer?

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000690 ◽

2016 ◽

Vol 26 (5) ◽

pp. 906-911 ◽

Cited By ~ 13

Author(s):

Luis M. Chiva ◽

Teresa Castellanos ◽

Sonsoles Alonso ◽

Antonio Gonzalez-Martin

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Median Overall Survival ◽

Residual Disease ◽

Disease Free Survival ◽

Advanced Ovarian Cancer ◽

Stage Iv ◽

Phase Iii ◽

Stage Iii ◽

Pubmed Database

ObjectiveThe objective of this review was to try to determine by searching in the literature what is the survival in patients with advanced ovarian cancer after a primary debulking with minimal macroscopic residual disease (MMRD; 0.1–10 mm). Additionally, this review aimed to explore the survival in patients with residual disease from 0.1 to 0.5 cm.MethodsA retrospective search was accomplished in the PubMed database looking for all English-language articles published between January 1, 2007 and December 31, 2014, under the following search strategy: “ovarian cancer and cytoreduction” or “ovarian cancer and phase III trial”. We selected those articles that contain information on both percentage of MMRD (0.1–1 cm) and median overall survival (OS) in this subset of patients with stage III to stage IV ovarian cancer after primary debulking surgery.ResultsThirteen publications were obtained including information of a total 11,999 patients with stage III to stage IV ovarian cancer. Five thousand thirty-seven patients (42%) had MMRD after the primary debulking (0.1–1 cm). Median overall survival in patients with MMRD was 40 months and disease-free survival (DFS) was 16 months. This group of patients obtained an advantage of 10 months in OS (40 vs 30 m) and 4 months in DFS (16 vs 12 m) compared with the group with suboptimal debulking (P < 0.001). Compared with the group of complete resection, patients with minimal macroscopic residuum showed a significant inferior median OS and DFS of 30 months and 14 months, respectively (OS, 70 vs 40 m; DFS, 30 vs 16 m) (P < 0.001). The group of residual disease of 0.1 to 0.5 cm reached a median survival of 53 months.ConclusionsPatients with ovarian cancer with MMRD after primary surgery obtain a modest but significant advantage in survival (10 months) over suboptimal patients. Patients with macroscopic residual disease (0.1–0.5 cm) obtain a better survival (53 months) than those with more than 0.5 to 1 cm. We propose that they should be classified as a different prognostic group.

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Prognostic impact of neo-adjuvant vs adjuvant vs neo-adjuvant plus adjuvant chemotherapy in advanced ovarian cancer: Analysis of National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.5552 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 5552-5552

Author(s):

Suresh Mukkamala ◽

Sukamal Saha ◽

Sabarina Ramanathan ◽

David Livert ◽

Rajen Oza ◽

...

Keyword(s):

Ovarian Cancer ◽

Bowel Resection ◽

Advanced Ovarian Cancer ◽

Stage Iv ◽

National Cancer Data Base ◽

Stage Iii ◽

Prognostic Impact ◽

Chi Square ◽

Cancer Data ◽

In The Beginning

5552 Background: Patients (Pts) with advanced ovarian cancer (OvCa) are usually treated with primary debulking (deb) surgery (Sx) followed by adjuvant (adj) chemotherapy (CRx). Recently neo-adjuvant (neo-adj) CRx is increasingly being used to reduce the bulk of the tumor. Hence, we analyzed for any prognostic impact of neo-adj vs adj vs neo-adj plus adj CRx along with deb Sx in the management of advanced OvCa. Methods: Only Stage III and IV Pts in National Cancer Data Base (NCDB) from 2006-2014, who underwent deb Sx without bowel resection (1), with bowel resection (2) and with bowel and bladder resection (3) were analyzed. Group (gp) A Pts had neo-adj CRx, gp B had adj CRx and gp C Pts had neo-adj plus adj CRx. The Pearson Chi square testing was used to evaluate the survival between gp A vs B vs C. Results: A total of 20910 Pts in stage III and 7483 Pts in stage 4 were included. Stage III Pts had a better 5 year (yr) survival in gp B compared to gp A and C, in all Pts who underwent Sx 1, 2 and 3 (Table 1). Stage IV Pts had a better 5 yr survival in gp C compared to gp A and B who underwent Sx 1 and 2, and gp B had a better 5 yr survival in Pts who underwent Sx 3 (Table 1). Overall survival was worse for all stages in Pts with neo-adj ( gp A) than gp Band C. Conclusions: Deb Sx followed by adj CRx had better survival than in gp A or C. This may be secondary to less bulkier disease in the beginning in gp B than those in gp A or C requiring neo-adj CRx for the later. Pts survival also improved after addition of adj CRx following deb Sx compared to no adj CRx. A prospective multicenter randomized trial between each group may further validate the true benefits of neo-adj CRx in advanced OvCa. [Table: see text]

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Plasma MicroRNA Levels Following Resection of Metastatic Melanoma

Bioinformatics and Biology Insights ◽

10.1177/1177932217694837 ◽

2017 ◽

Vol 11 ◽

pp. 117793221769483 ◽

Cited By ~ 16

Author(s):

Nicholas Latchana ◽

Zachary B Abrams ◽

J Harrison Howard ◽

Kelly Regan ◽

Naduparambil Jacob ◽

...

Keyword(s):

Surgical Resection ◽

Inflammatory Responses ◽

Expression Profiles ◽

Stage Iv ◽

Principal Component ◽

Stage Iii ◽

Disease Stage ◽

Stage Iv Disease ◽

Group A ◽

Group B

Melanoma remains the leading cause of skin cancer–related deaths. Surgical resection and adjuvant therapies can result in disease-free intervals for stage III and stage IV disease; however, recurrence is common. Understanding microRNA (miR) dynamics following surgical resection of melanomas is critical to accurately interpret miR changes suggestive of melanoma recurrence. Plasma of 6 patients with stage III (n = 2) and stage IV (n = 4) melanoma was evaluated using the NanoString platform to determine pre- and postsurgical miR expression profiles, enabling analysis of more than 800 miRs simultaneously in 12 samples. Principal component analysis detected underlying patterns of miR expression between pre- vs postsurgical patients. Group A contained 3 of 4 patients with stage IV disease (pre- and postsurgical samples) and 2 patients with stage III disease (postsurgical samples only). The corresponding preoperative samples to both individuals with stage III disease were contained in group B along with 1 individual with stage IV disease (pre- and postsurgical samples). Group A was distinguished from group B by statistically significant analysis of variance changes in miR expression ( P < .0001). This analysis revealed that group A vs group B had downregulation of let-7b-5p, miR-520f, miR-720, miR-4454, miR-21-5p, miR-22-3p, miR-151a-3p, miR-378e, and miR-1283 and upregulation of miR-126-3p, miR-223-3p, miR-451a, let-7a-5p, let-7g-5p, miR-15b-5p, miR-16-5p, miR-20a-5p, miR-20b-5p, miR-23a-3p, miR-26a-5p, miR-106a-5p, miR-17-5p, miR-130a-3p, miR-142-3p, miR-150-5p, miR-191-5p, miR-199a-3p, miR-199b-3p, and miR-1976. Changes in miR expression were not readily evident in individuals with distant metastatic disease (stage IV) as these individuals may have prolonged inflammatory responses. Thus, inflammatory-driven miRs coinciding with tumor-derived miRs can blunt anticipated changes in expression profiles following surgical resection.

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Trends in demographics and survival for patients (pts) with advanced non-small cell lung cancer (NSCLC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7114 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7114-7114

Author(s):

K. Kubota ◽

H. Masuhara ◽

K. Hosoya ◽

K. Yoh ◽

S. Niho ◽

...

Keyword(s):

Kinase Inhibitors ◽

Statistical Significance ◽

Performance Status ◽

Stage Iv ◽

Stage Iii ◽

Smoking History ◽

Rank Test ◽

Cancer Center ◽

Group A ◽

Group B

7114 Background: In clinical trials, concurrent chemoradiotherapy improves survival of pts with inoperable stage III NSCLC compared with sequential chemoradiotherapy or radiotherapy alone, and platinum doublets with third-generation chemotherapy prolong survival of pts with stage IV NSCLC. Epidermal growth factor receptor antagonist is active as second-line chemotherapy. Few outcomes research regarding demographics and survival trends in advanced NSCLC has been conducted. Methods: The National Cancer Center Hospital East Database was searched for all pts with inoperable stage III and IV NSCLC. Data was recorded for histology, age, sex, smoking history, tumor location, stage, performance status (PS), and treatment modality. Pts were divided into two groups; group A: newly registered pts from July 1992 to December 1997, group B: from January 1998 to June 2004. Survival curves were evaluated using the Kaplan-Meier methods, and statistical significance was estimated by the log-rank test. Results: 2,135 pts (771 pts group A vs. 1364 pts group B) were identified. Pts demographics of each group (% group A/B) were as follows; male; 74/77, non-smoker; 19/19, PS 0–1; 79/85, squamous cell histology; 26/24, stage III; 45/44. Median age was 63 years old in group A and 64 in group B. Median survival (MS), 1-year survival rate (1ys), 2ys and 3ys were 8 months (M), 33%, 12% and 7% in group A, 10M, 42%, 23% and 14% in group B, respectively (P < .0001). In pts with stage III, MS, 1ys, 2ys, 3ys were 12M, 46%, 20%, 12% in group A and 15M, 56%, 34%, 20% in group B (P < .0001). In non-smoker, MS, 1 ys, 2 ys were 11 M, 46%, 19% in group A and 15 M, 56%, 30% in group B (P < .0001). In females, MS, 1 ys, 2 ys were 10 M, 39%, 16% in group A and 15 M, 55%, 31% in group B (P < .0001). Conclusion: Although there were no apparent differences in demographics between the two groups, survival was significantly improved chronologically. The improvement was prominent in stage III, non-smokers and females suggesting the benefit of chemoradiotherapy and tyrosine kinase inhibitors. [Table: see text]

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Improved 5-year overall survival (OS) in breast cancer (CA) patients from 1994 to 2008.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e13126 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e13126-e13126

Author(s):

David Naji Aljadir ◽

Francis J. Cummings

Keyword(s):

Overall Survival ◽

National Level ◽

Metastatic Breast ◽

Stage Iv ◽

Stage Ii ◽

Stage Iii ◽

National Cancer Database ◽

Canadian Study ◽

The Us ◽

Northeast Us

e13126 Background: A Canadian Study (Chia, ASCO 2003, Abstract 22) comparing OS across 4 time cohorts in patients with metastatic Breast CA demonstrated OS benefit at 1 and 2 years that appears related to the release of aromatase inhibitors (AI)/docetaxel and trastuzumab/capecitabine but not paclitaxel or vinorelbine. Methods: 5 yr overall survival (OS5) in breast CA patients (all stages) was separated into 3 time cohorts corresponding to dates of release of chemotherapy or hormonal treatments (cohort 1:1994-1997 (paclitaxel/vinorelbine), cohort 2:1998-2002 (AI /trastuzumab) and cohort 3:2003 (bevacizumab)) to determine if there was an impact on OS5 in all stages and if there was a relation to survival based on stage of disease. Data was extracted from the National Cancer Database (NCDB) for the US and Northeastern US (MA, ME, CT, RI, VT, NH). Results: The OS5 in the US was 80.0% [CI 80.6-80.9], 84.7% [CI 84.4-84.6] and 85% [CI 84.8-85.2] for cohorts 1, 2 and 3, respectively. The OS5 in the Northeast US was 82.3% [CI 81.8-82.8], 85.7% [CI 85.4-86.1] and 87.3% [CI 86.6-88.0] for cohorts 1, 2 and 3, respectively. Stage II 5 yr survival in the US was 78.9% [CI 78.7-79.1], 82.8% [CI 82.6-83.0] and 84.8% [CI 84.4-85.2] and in the Northeast US was 79.1% [CI 78.2-80], 82.4% [CI 81.7-83.1] and 83.7% [CI 82.2-85.3] for cohorts 1,2, and 3, respectively. 5 yr survival for stage III in the US was 53.8% [CI 53.2-54.3], 57.8% [CI 57.3-58.3] and 64.5% [CI 63.7-65.4] and in the Northeast US was 53.2% [CI 50.9-55.6], 58.8% [CI 56.7-60.8], and 70.7% [CI 67.3-74.1] for cohorts 1,2 and 3, respectively. Stage IV patients showed no change in 5 yr survival over the 3 cohorts, but showed improvement in 2 yr survival at the National Level (44.6%, 46.1%, and 46.7%) and in the Northeast US (46.7%,47.5% and 49.4%) for cohorts 1,2 and 3,respectively. Conclusions: 5 yr survival in stage II and stage III breast CA between cohorts 1 and 3 has improved, whereas stage IV survival at 5 yrs showed no improvement in any cohort, even though there was an improvement in stage IV 2 yr survival in the US and within the Northeast US. The improvement in OS5 is more pronounced between cohorts 1 and 2 than between cohorts 2 and 3, which appears to correspond to the addition of AI and trastuzumab.

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Surgery provides survival benefit over systemic therapy alone for stage IV triple negative breast cancer: A propensity matched analysis of the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13054 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13054-e13054

Author(s):

Lifen Cao ◽

Jonathan T. Bliggenstorfer ◽

Kavin Sugumar ◽

Christopher W. Towe ◽

Pamela Li ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Systemic Therapy ◽

Survival Benefit ◽

Triple Negative ◽

Stage Iv ◽

National Cancer Database ◽

Propensity Matching ◽

N Stage ◽

Metastatic Sites

e13054 Background: Conflicting data exist regarding benefit of surgery of the primary site for stage IV breast cancer, in which systemic therapy is standard of care and patient characteristics may bias treatment decisions. Metastatic triple negative breast cancer (TNBC) is an aggressive subtype with limited therapy options and poor prognosis. Our aim was to assess whether surgery for the primary tumor in stage IV TNBC provides a survival advantage over systemic therapy alone. Methods: The National Cancer Database was queried for patients with de-novo stage IV TNBC who received systemic therapy alone or systemic therapy and surgery of the primary breast site 2004-2016. Patients receiving surgery for metastatic tumor sites or with incomplete follow up data were excluded. 1:1 propensity matching was performed for demographics, comorbidities, clinical T and N stage, and metastatic sites to minimize confounding factors. Survival outcomes were analyzed using a stratified log-rank test and Cox proportional hazard regression analysis. Results: Of 2989 patients, 782 (26.21%) underwent surgery plus systemic therapy and 2207 (73.84%) were treated with systemic therapy alone. The majority of all patients were aged 51-70 with low co-morbidity, and treated in metropolitan areas. Patients treated at academic facilities (OR = 0.67, p = 0.025), with multiple metastatic sites (OR = 0.59, p < 0.001), or advanced clinical N stage (OR = 0.55, p < 0.001) were less likely to undergo surgery. Of those who completed surgery, 58% had unilateral mastectomy, and 63% had axillary lymph node dissection. Propensity matching identified 507 ‘paired’ patients with similar characteristics in the surgery and systemic therapy alone groups. After multivariable adjustment, surgery was associated with superior overall survival compared with systemic therapy alone (HR 0.73, P < 0.001). Older age (HR = 1.47, p < 0.001), greater comorbidity (HR = 1.28, p < 0.001) and multiple metastatic sites (HR = 1.53, p < 0.001) significantly decreased overall survival in the matched cohort. Median survival was shortest in the systemic therapy alone group (12.8 months, 95% CI 11.3-14.5) and longest in those undergoing systemic therapy plus simple mastectomy (18 months, 95% CI 14.3-21.2), though approximately 4 months of median survival was added for all patients undergoing any surgery vs. systemic therapy alone (p = 0.0001). Conclusions: In stage IV TNBC, surgical resection of the primary tumor site in addition to systemic therapy may provide a survival benefit in selected patients. Though in this retrospective study the sequence of treatment was unknown, surgery could be considered for low disease burden as in other malignancies with oligometastatic disease. Additional research is needed to determine if these findings persist in prospective studies and for other hormone-receptor subtypes.

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