375P - Breast carcinoma with distant metastasis at initial presentation: impact of breast surgery in real-life clinical practice

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Breast Cancer, Metastatic
Surgery and/or Radiotherapy of Cancer
Presenter Ivo Dias
Citation Annals of Oncology (2014) 25 (suppl_4): iv116-iv136. 10.1093/annonc/mdu329
Authors I.J. Dias1, A.S.J. Patrão1, J. Savva-Bordalo1, A. Simas1, A.F. Carneiro1, A.C. Teixeira2, L. Antunes3, M.I.R. Ferreira1, D. Pereira1, N. Afonso1
  • 1Oncologia Médica, Instituto Portugues de Oncologia Centro do Porto(IPO-Porto), 4200-072 - Porto/PT
  • 2Oncologia Médica, Centro Hospitalar do Alto Ave, 4180 - 052 - Guimarães/PT
  • 3Epidemiologia, Instituto Portugues de Oncologia Centro do Porto(IPO-Porto), 4200-072 - Porto/PT

Abstract

Aim

About 5–10% of breast cancer (BC) patients (pts) are metastatic breast carcinoma (MBC) at diagnosis. Systemic therapy is the usual initial approach in this setting. Radical locoregional surgery is still controversial. The present study aims to assess the use and impact of breast surgery in MBC outcome in real-life clinical practice.

Methods

Retrospective series of cases of MBC at diagnosis admitted in our Institution between 1995 and 2008. Medical records were reviewed with collection of demographic and clinical variables. Population characterization was performed using descriptive statistics. Survival analysis was assessed through Kaplan-Meier and log-rank test for subgroups comparison. Uni and multivariate analysis for prognostic variables was accomplished by Cox proportional hazard model

Results

We identified 326 MBC pts at presentation (3% of all BC pts). Median age was 59 yr (range 20-91). Most pts (238 - 75%) had positive hormonal receptors (HR) and 130 (44%) were cT4. Visceral metastases were identified in 134 pts. Surgery was the first treatment in 79 pts (24%), while the majority (71%) were initially treated with systemic approach. Among pts treated initially with systemic therapy, 50% were submitted to surgery afterwards. Fifteen pts (5%) were proposed for best supportive care upfront. Median overall survival (OS) was 21 months, with 5-year survival of 20% (95% CI 17,6-24,4). Patients submitted to surgery present the best OS rates, either if performed as initial therapy (27vs20 months, p = 0,003) or after systemic therapy (38vs10 months, p < 0,001). Patients with bone metastasis only, were the group benefiting the most from surgery (39vs10 months, p < 0,001). For visceral metastasis the benefit of breast surgery was only evident if performed after initial systemic therapy (36vs8 months, p < 0.001). In multivariate analysis, surgery presented as an independent prognostic factor when adjusted for HR, grade, visceral and bone metastasis

Conclusions

The present review confirms the common use of breast surgery in real-life practice for MBC at diagnosis, with a favourable impact in outcome. Our data suggest that the best timing for breast surgery is after systemic treatment, supporting the importance of distant metastasis control before locorregional treatment

Disclosure

All authors have declared no conflicts of interest.