Abstract
Background. Women with metastatic breast cancer and an intact primary tumor are currently treated
with systemic therapy. Local therapy of the primary tumor is considered irrelevant
to the outcome, and is recommended only for palliation of symptoms. Methods. We have examined the use of local therapy, and its impact on survival in patients
presenting with stage IV breast cancer at initial diagnosis, who were reported to
the National Cancer Data Base (NCDB) between 1990 and 1993. Results. A total of 16,023 patients with stage IV disease were identified in the NCDB during
this period, of whom 6861 (42.8%) received either no operation or a variety of diagnostic
or palliative procedures, and 9162 (57.2%) underwent partial (3513) or total (5649)
mastectomy. The presence of free surgical margins was associated with an improvement
in 3-year survival in partial or total mastectomy groups (26% vs 35%, respectively).
A multivariate proportional hazards model identified the number of metastatic sites,
the type of metastatic burden, and the extent of resection of the primary tumor as
significant independent prognostic covariates. Women treated with surgical resection
with free margins, when compared with those not surgically treated, had superior prognosis,
with a hazard ratio of 0.61 (95% confidence interval 0.58,0.65). Conclusions. These data suggest that the role of local therapy in women with stage IV breast cancer
needs to be re-evaluated, and local therapy plus systemic therapy should be compared
with systemic therapy alone in a randomized trial. Surgery 2002;132:620-7.
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Article info
Footnotes
*Reprint requests: Seema A. Khan, MD, Department of Surgery, Northwestern University Medical School, 201 E Huron St, Suite 10-105, Chicago, IL 60611.
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© 2002 Published by Elsevier Inc.
