This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gnerlich, J. Articles by Margenthaler, J. A. Search for Related Content PubMed PubMed Citation Articles by Gnerlich, J. Articles by Margenthaler, J. A.

Surgical Removal of the Primary Tumor Increases Overall Survival in Patients With Metastatic Breast Cancer: Analysis of the 1988–2003 SEER Data

¹ Department of Surgery, Washington University School of Medicine, 660 S Euclid, Campus, Box 8109, St. Louis, Missouri 63110
² Department of Medicine, Washington University School of Medicine, 4444 Forest Park Blvd, Campus Box 8504, St. Louis, Missouri 63110
³ Department of Community Health, Saint Louis University School of Public Health, 3545 Lafayette Avenue, St. Louis Missouri 63104

Correspondence: Address correspondence and reprint requests to: Julie A. Margenthaler, MD; E-mail: margenthalerj{at}wudosis.wustl.edu

Background: Primary treatments for stage IV breast cancer are chemotherapy and radiation, with surgery usually reserved for tumor-related complications. We sought to determine whether surgical removal of the primary tumor provides a survival advantage for women with metastatic breast cancer.

Methods: We conducted a retrospective, population-based cohort study by using the 1988–2003 Surveillance, Epidemiology, and End Results (SEER) program data. By use of multivariate Cox regression models, overall survival in women with stage IV disease was compared between women who underwent surgical excision of their breast tumor with women who did not, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores (accounting for variables associated with the likelihood of having surgery).

Results: Of 9734 SEER patients with stage IV breast cancer, 47% underwent breast cancer surgery and 53% did not. Median survival was longer for women who had surgery than for women who did not, both among women who were alive at the end of the study period (36.00 vs. 21.00 months; P < .001) and among women who had died during follow-up (18.00 vs. 7.00 months; P < .001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery were less likely to die during the study period compared with women who did not undergo surgery (adjusted hazard ratio, .63, 95% confidence interval, .60–.66).

Conclusions: Analysis of the 1988–2003 SEER data indicated that extirpation of the primary breast tumor in patients with stage IV disease was associated with a marked reduction in risk of dying after controlling for variables associated with survival.

Key Words: Stage IV breast cancer • SEER data • Survival • Surgery

This article has been cited by other articles:

				R. Le Scodan, D. Stevens, E. Brain, J. L. Floiras, C. Cohen-Solal, B. De La Lande, M. Tubiana-Hulin, S. Yacoub, M. Gutierrez, D. Ali, et al. Breast Cancer With Synchronous Metastases: Survival Impact of Exclusive Locoregional Radiotherapy J. Clin. Oncol., March 20, 2009; 27(9): 1375 - 1381. [Abstract] [Full Text] [PDF]

				B. Cady, N. R. Nathan, J. S. Michaelson, M. Golshan, and B. L. Smith Matched Pair Analyses of Stage IV Breast Cancer with or Without Resection of Primary Breast Site Ann. Surg. Oncol., December 1, 2008; 15(12): 3384 - 3395. [Abstract] [Full Text] [PDF]

				W. J. Gradishar, J. R. Bellon, M. A. Gadd, H. A. D'Alessandro, and K. Braaten Case 30-2008 -- A 47-Year-Old Woman with a Mass in the Breast and a Solitary Lesion in the Spine N. Engl. J. Med., September 25, 2008; 359(13): 1382 - 1391. [Full Text] [PDF]