Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer

• Published in: Cancer Vol. 113; no. 8; pp. 2011 - 2019
• Main Authors: Hazard, Hannah W., Gorla, Seema R., Scholtens, Denise, Kiel, Krystyna, Gradishar, William J., Khan, Seema A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.10.2008; Wiley-Liss
• Subjects: Biological and medical sciences; breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - surgery; chest wall disease; Female; Gynecology. Andrology. Obstetrics; Humans; Kaplan-Meier Estimate; locoregional control; Mammary gland diseases; Medical sciences; Middle Aged; overall survival; Thoracic Wall - pathology; time to first progression; Tumors; Human; chest wall disease; Breast disease; Diseases of the osteoarticular system; Surgical resection; Breast cancer; Malignant tumor; Metastasis; Survival; time to first progression; Chest wall tumor; Mammary gland diseases; Cancerology; Treatment; Surgery; Primary; locoregional control; overall survival; Adult; Female; Advanced stage; Woman; Chest wall; Cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23870

BACKGROUND Among women presenting with de novo stage IV breast cancer, 35% to 60% undergo local therapy, presumably to avoid uncontrolled chest wall disease. Several studies suggest that resection of the primary tumor may prolong survival, but chest wall outcome data are notably lacking. The authors reviewed chest wall status, time to first progression (TTFP), and overall survival (OS) in this group of women. METHODS Women presenting at the Lynn Sage Breast Center (1995‐2005) with an intact primary tumor and stage IV breast cancer or postoperative diagnosis of distant metastases were identified. Logistic regression and Cox proportional hazards models, adjusted for relevant covariates, were used to examine associations between surgical treatment and chest wall status, TTFP, and OS. RESULTS Of 111 eligible women, 47 (42%) underwent early resection of the primary tumor. Chest wall status was available for 103 women. Local control was maintained in 36 of 44 (82%) patients in the surgical group versus 20 of 59 (34%) patients without surgery (P = .001). TTFP was prolonged in the surgical group (adjusted hazards ratio [HR], 0.493; P = .015). The adjusted HR for OS in the surgical group was 0.798 (P = .520). Chest wall control was associated with improved OS regardless of whether surgical resection of the tumor was performed (HR, 0.415; P < .0002). CONCLUSIONS These data support the notion that improved local control may play a role in improving outcomes in women with stage IV breast cancer, and resection of in‐breast tumors can help to achieve this. A randomized trial is needed to rule out selection bias as an explanation for these findings. Cancer 2008. © 2008 American Cancer Society. Among women who present with stage IV breast cancer and an intact primary tumor, the impact of surgical therapy on chest wall control has not been examined so far. The authors performed a retrospective, single‐institution study of this question and found that 1) surgical resection is significantly protective against symptomatic chest wall disease, and 2) women with controlled chest walls live longer than those with uncontrolled local disease.