Breast surgery for patients with de novo metastatic breast cancer: A meta-analysis

Abstract

Abstract Background The role of breast surgery in the treatment of patients with de novo metastatic breast cancer (dnMBC) remains controversial, with conflicting trial results. We did a meta-analysis to comprehensively investigate and assess whether breast surgery is associated with survival and quality of life outcomes in patients with dnMBC. Methods We systematically searched PubMed, Embase, Google Scholar, Scopus, and Web of Science, from database inception to March 30, 2022, for randomised controlled trials (RCTs) that compared breast surgery or locoregional therapy with non-surgical treatment based on systemic therapy for managing dnMBC. We also reviewed abstracts and presentations from major conference proceedings. We excluded non-randomised trials and considered only papers published in English. The primary outcomes were overall survival (OS), locoregional progression-free survival (LPFS), distant progression-free survival (DPFS), and quality of life (QoL).The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects model was used to calculate the effect sizes of included RCTs.The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. Data analysis was performed with STATA version 17.0 (Statacorp, college station, Tex). Results A total of 1018 women from seven randomized clinical trials were included in the analysis. Pooled analyses revealed that compared with systemic therapy, breast surgery was not associated with beneficial outcomes in OS (hazard ratio [HR], 0.87; 95% CI, 0.68 to 1.11), DPFS (HR, 0.96; 95% CI, 0.41 to 2.22), or QoL (standardized mean difference [SMD], -0.26; 95% CI,-0.58 to 0.06), but was associated with a benefit in LPFS (HR, 0.36; 95% CI, 0.13 to 0.96).These findings were consistent in subgroup analyses of the timing of surgery, site and number of metastases and tumor molecular subtype.The evidence grade was moderate because of the substantial heterogeneity among studies. Conclusions Based on the RCTs evidence, we found that breast surgery may benefit locoregional control but does not prolong OS and improve QoL in patients with dnMBC.