Surgery Can Improve 5-year Survival Of Patients With Stage Ⅳ TPBC (Triple Positive Breast Cancer)

Objective:This study retrospectively analyzed the effect of surgery on the prognosis of stage IV triple-positive breast cancer patients by referring to the SEER database,as well as the difference of the effect of two different surgical methods(total mastectomy and palliative tumor resection)on the prognosis.Methods:Chi-square test was used to compare the difference of patients characteristics.Kaplan–Meier and log-rank analyses were used to evaluate the OS(overall survival)and CSS(cancer-specific survival)between the two groups,were further involved in the multivariate analysis using a Cox proportional hazards model.We performed a 1:1 case matched analysis based on whether performed surgery and matching for age,race,pathological T stage,pathological N stage,grade,chemotherapy and radiotherapy,using the propensity score matching method to control for confounding variables.All statistical tests were 2-tailed and P values less than0.05 were considered to be statistically significant.Statistical analyses were done with SPSS 25.0 software.Results:Finally,we identified 934 eligible patients with stage IV Triple-positive breast cancer.Of these patients,370(39.6%)underwent surgery for the primary tumor(surgery group),while 564(60.4%)had no surgical treatment(non surgery group).Patients who underwent surgery had a better 5-year CSS than those who did not(65.1%vs29.7%,P < 0.0001;)and 5-year OS(62.2%vs28%,P <0.0001).In the multivariate Cox regression model,patients who underwent surgery had better CSS(HR: 0.43,95%CI: 0.335-0.551,P <0.0001)and OS(HR:0.425,95%CI:0.335-0.541,P <0.0001)than those didn’t,age and chemotherapy can also be considered as independent prognostic factors.The results were further confirmed in the 1:1 matched group.For patients who have already had surgery,the type of surgery also affects the 5-year survival.Patients who underwent tumor resection had better5-year CSS(63.9%vs32.7%,P < 0.0001)and 5-year OS(71.3%vs58.1%,P=0.011)than those who underwent mastectomy.Conclusion:For stage IV triple-positive breast cancer patients,can still benefit from surgery.But this benefit is limited to tumor resection.The survival benefit of patients who performed tumor resection was greater than that of patients who performed mastectomy.It is mainly considered that triple-positive breast cancer can achieve better curative effect mainly through systemic treatment,and tumor resection can achieve better curative effect,which is superior to mastectomy.