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Impact of breast surgery on response and survival in metastatic breast cancer patients

Objective The aim of this study was to assess the impact of primary tumor resection on the survival and quality of life in women with stage IV breast cancer. Background About 3-10% of patients with breast cancer have distant metastases (stage IV) at initial presentation. Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined strictly to palliation. However, retrospective studies have shown improved survival in patients who have undergone surgery for their primary tumor. Thus, new clinical questions have emerged in terms of surgery of the primary site in those women with metastatic disease and a resectable intact primary tumor. Patients and methods This study included patients with stage IV breast cancer who presented to the Clinical Oncology Department, Menoufia University, from September 2009 till August 2011. Patients were divided on the basis of treatment into two groups: those who underwent surgery and those who did not undergo surgery. All patients then received anthracyclin-based chemotherapy, followed by hormonal treatment according to hormonal status. Patient characteristics and survival were evaluated using univariate and multivariable analyses. Results In total, 151 patients were included in this analysis; 61 patients underwent surgery and 90 patients did not. The median survival of the patients who underwent surgery for their primary tumor was significantly longer than that for the patients who did not undergo surgery (39 vs. 24 months). The median time to progression in the surgery group was 26 months versus 13 months in the no-surgery group. The 2-year survival was 73.8% in the surgery group compared with 38.9% in the no-surgery group. A multivariate proportional hazards model identified the grade of tumor as a significant independent prognostic factor. Conclusion Primary tumor resection increased survival in patients with metastatic breast cancer. Thus, the role of surgery in women with stage IV breast cancer needs to be re-evaluated.