Palliative surgery versus non-surgery of the solitary metastatic lesion in De novo metastatic breast cancer: A SEER based study

Author:

Yue Jian123,Wang Jing45,Chen Wei6,Yin Xuedong12,Du Huimin7,Wei Yuxian12ORCID

Affiliation:

1. Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

2. Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

3. Department of Breast Surgery, Gaozhou People’s Hospital, Gaozhou, China

4. Department of Head, Neck and Breast Surgery, Anhui Provincial Cancer Hospital, Hefei, China

5. Department of Head, Neck and Breast Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China

6. Youyang Hospital, A Branch of The First Affiliated Hospital of Chongqing Medical University, Youyang, China

7. Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

This study aimed to evaluate whether palliative surgery for metastatic lesion could provide a survival benefit in metastatic breast cancer (MBC) patients with solitary metastasis. De novo MBC patients with solitary distant lesions were enrolled utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to form matched pairs of the surgery group and the non-surgery group. The breast cancer-specific survival (BCSS) and overall survival (OS) outcomes between the 2 groups were compared in the following 3 sample models: the entire cohort of MBC (7665 cases); subgroups of patients with different isolated metastatic organs; and subgroups of patients with different molecular subtypes for each isolated metastatic organ. Compared with the Non-surgery group, the surgery group showed better BCSS and OS before PSM (HR = 0.88, 95% CI = 0.79–0.99, P = .04 and HR = 0.85, 95% CI = 0.76–0.95, P = .006, respectively). After PSM, palliative surgery still provided an OS benefit in patients with brain metastasis and lung metastasis (HR = 0.59, 95% CI = 0.37–0.95, P = .01 and HR = 0.64, 95% CI = 0.45–0.90, P = .02, respectively). Likewise, a better BCSS benefit was also found in the subset of patients with brain metastasis (HR = 0.61, 95% CI = 0.38–1.00, P = .01). Further stratification analysis indicated that patients with the luminal A subtype with brain metastasis have a better BCSS (HR = 0.36, 95% CI = 0.16–0.79, P = .04) and OS (HR = 0.37, 95% CI = 0.18–0.75, P = .03) after undergoing palliative surgery than nonsurgical treatment. Our study originality showed that palliative surgery for metastatic lesion could improve survival prognosis in patients with special single-organ metastasis and specific molecular subtypes. More clinical studies are needed to determine whether palliative surgery should be performed in MBC patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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