To Investigate The Value Of Primary Tumor Resection In Stage IV Breast Cancer

Objective: To investigate the value of primary tumor resection and analyze the suitable operative methods and handling ways in stage ? breast cancer patients.Methods: We performed a review of patients who presented with stage IV breast cancer in the 4th Hospital, Hebei Medical University from June 2008 to June 2015, All cases were divided into surgical and non- surgery groups. The value of primary tumor resection and the impact of the operative methods or handling ways on overall survival and progression free survival time after surgery were analyzed.Results:1 Of the 132 women who presented with stage IV breast cancer, 85(65%) underwent mastectomy or lumpectomy. Compared with patients in the nonsurgery group, patients in the surgery group were younger(P=0.033). The median age at diagnosis in the surgery group was 51.07 years compared with 55.51 years in the no-surgery group. In the surgery group, 21 patients(24.7%) were combined with chronic disease, compared with 19 patients(40.4%) in the non-surgery group. There were no significant difference in comorbidity between the two groups(P=0.06). The proportion of patients with visceral metastases of surgical and nonsurgical patients were 61.1% and 74.5%; The proportion of patients with only bone metastasis in surgery group and non-surgery group were 19.1% and 23.5%; In terms of quantity of metastasis and visceral metastases, the disease of non-surgery group were more advanced, While, these factors in the two groups had no significant difference(P = 0.39, P = 0.12). There was no difference in T stage, Menopausal status, estrogen and progesterone receptor status, HER-2, sites of metastases.2 Median overall survival of nonsurgical group was 20.9 months(95% confidence interval, 15.6-20.1 months). Median overall survival of surgical group was 46.7 months(95% confidence interval, no data). Kaplan-Meier curves demonstrated the difference between the surgery group and the non-surgery group in overall survival(P=0.010).On univariate analysis, overall survival seemed to be associated with T stage(P=0.033), Sites of metastases(P=0.004), Type of metastatic disease(P=0.004). Multivariate analysis demonstrated improved overall survival for patients who underwent breast surgery(HR=0.500;95% CI:0.284-0.881;P=0.016)and fewer sites of metastases(HR=1.187;95% CI:1.262-2.616;P=0.001).After adjustment for age, surgery was associated with an improvement in overall survival in patients aged above 50(P=0.009). While, in patients aged 50 at most we did not find the difference in overall survival(P=0.352).3 Of 85 stage IV patients in surgery group, 79 received chemotherapy before surgery. Number of chemotherapy cycles seemed to not be associated with the overall survival(P=0.171). Surgical extirpation of the primary tumor is associated with improved progression free survival time to surgery when performed in 6 cycles chemotherapy(P=0.0090).In terms of optimum timing for surgery, the median time to surgery was 132 days. Patients who underwent surgery in the 3 month after diagnosis did not have significantly different survival and progression free survival time to surgery compared with patients who underwent surgery more than 3 months after diagnosis(P=0.129;P=0.05).we also evaluated the effect of chemotherapy response in the two subgroups of paients(CR+PR vs SD+PD). There were no difference on overall survival and progression free survival time to surgery between two subgroups according to Kaplan-Meier curves(P=0.743; P=0.523).we evaluated the effect of surgery with and without axillary lymph node dissection in the two subgroups. 34 patients underwent ALND, 44 patients underwent excision of axillary lymph node. No difference on survival between two subgroups(P=0.077). Surgical extirpation of the primary tumor is associated with improved progression free survival time to surgery when performed with axillary lymph node dissection(P=0.022).Kaplan-Meier curves demonstrated the difference between subgroup of radiotherapy after surgery and subgroup without radiotherapy in the overall survival and progression free survival time to surgery of surgery group(P=0.013; P=0.028), Median overall survival of subgroup of radiotherapy after surgery was 616 days(95%CI:249-983 days),compared with 255 days(95%CI:121-389 days) in subgroup without radiotherapy.Conclusions:1 Removal of the intact primary tumor for selective breast cancer patients with stage IV disease is associated with improvement in overall survival.2 Radiotherapy after surgery could further improve overall survival in patients of surgerical group. The survival benefit of surgical treatment was not related to the duration of operation, the number of preoperative chemotherapy cycles, the remission of tumor after preoperative treatment, and axillary lymph node dissection.3 Primary tumor surgery should be underwent on the basis of fully effective system treatment, and not be done immediately after diagnosis. we demonstrated that resection of the intact primary tumor with ALND could be associated with improved PFS to surgery.4 Prospective studies are needed to validate these findings, And in the process of design of experiment, we should be attention to the specific details related to the operation problem.