368P - Is surgery of the primary tumor convenient in metastatic breast cancer?

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Breast Cancer, Metastatic
Surgery and/or Radiotherapy of Cancer
Presenter Fausto Petrelli
Authors F. Petrelli1, M. Cabiddu2, K.F. Borgonovo3, M. Ghilardi4, F. Maspero2, M. Cremonesi2, S. Barni5
  • 1Uo Oncologia, Azienda Ospedaliera Treviglio-Caravaggio, IT-24047 - Treviglio/IT
  • 2Medical Oncology Division, Azienda Ospedaliera Treviglio-Caravaggio, 24047 - Treviglio/IT
  • 3Oncologia Medica E Chemioterapia, A.O. Treviglio-Caravaggio, 24047 - Treviglio/IT
  • 4Medical Oncology Division, A.O. Trevilgio-Caravaggio, 24047 - Treviglio/IT
  • 5Azienda Ospedaliera Treviglio-Caravaggio, 24047 - Treviglio/IT

Abstract

Introduction

Stage IV breast cancer is treated primarily with systemic therapies. Excision of the primary breast cancer tumor in presence of synchronous distant metastases is a controversial argument, and a standard recommendation is not proposed by current guidelines. We performed a meta-analysis with the aim of pooling the existing survival data of surgery of the breast primary tumor in stage IV disease.

Materials and methods

We searched PubMed for publications including female, with histologically confirmed stage IV breast cancer at presentation and an intact primary tumor. Primary outcome was overall survival (OS) in patients treated with resection of primary breast cancer in presence of synchronous distant metastases. Secondary endpoints were PFS or TTP (and local and/or distant PFS or TTP, whichever reported). Hazard ratios (HRs) for survival when reported after multivariate analysis (with 95% confidence intervals) were obtained from publications and aggregated in a meta-analysis. A meta-regression weighted for extent of disease, ER/HER2 status, age, visceral or bone disease, rate of radiotherapy, and systemic therapies offered was also performed.

Results

15 articles were included in this meta-analysis (all retrospective case series), for a total of 15.378 patients. Surgery of the primary breast cancer appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with an HR of 0.69 (p < 0.00001). According to meta-regression, the survival benefit was independent of age, extent, site of metastatic disease and HER2 status, but was directly proportional to rate of patients exposed to systemic therapies and radiotherapy and inversely correlated to ER+ status of the population included.

Conclusions

Our pooled-analysis, reveals that surgery of an intact primary tumor, although associated with distant metastases, reduces the risk of death by 30%. This results are particular significant if local surgery is associated with systemic therapy and radiotherapy into a multimodality strategy. The surgical excision of a primary breast cancer in patients with stage IV disease – if feasible - should be discussed with and proposed to patients.

Disclosure

All authors have declared no conflicts of interest.