Surgical Resection of the Primary Tumor in Women With De Novo Stage IV Breast Cancer: Contemporary Practice Patterns and Survival Analysis.
Surgical Resection of the Primary Tumor in Women With De Novo Stage IV Breast Cancer: Contemporary Practice Patterns and Survival Analysis.
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DOI：
10.1097/sla.0000000000002621
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发表时间：
2019-03
影响因子：
9
通讯作者：
Greenup RA
中科院分区：
文献类型：
--
作者：
Lane WO;Thomas SM;Blitzblau RC;Plichta JK;Rosenberger LH;Fayanju OM;Hyslop T;Hwang ES;Greenup RA
我们评估了手术护理模式及其与当代IV期乳腺癌妇女总生存率的关系。手术切除原发肿瘤在IV期乳腺癌妇女中仍有争议。从2003年到2012年被诊断为临床IV期乳腺癌的女性是从美国外科医师学会国家癌症数据库中确定的。诊断后存活12个月的完整原发肿瘤患者按治疗顺序分类：(1)手术前全身治疗，(2)手术前全身治疗，(3)单独全身治疗。采用多变量logistic回归估计治疗顺序与手术类型的相关性。使用多变量Cox比例风险模型估计总生存率。在24,015名女性中，56.2%（13,505）接受了单独的全身治疗，43.8%（10,510）接受了手术切除。手术率随着时间的推移略有下降（从2003年的43.1%下降到2011年的41.9%）。与先接受手术的患者相比，术前接受全身治疗与更大的肿瘤大小（中位数为4.5 cm vs 3.1 cm, P < 0.001）和接受乳房切除术（81.4% vs 52.2%, P < 0.001）相关。接受手术，无论是在全身治疗之前还是之后（风险比，0.68；95%可信区间，0.62-0.73；风险比，0.56；95%可信区间，0.52-0.61;P < 0.001），与单独接受全身治疗相比，与改善的调整总生存率独立相关。在诊断后存活1年的IV期乳腺癌患者中，手术切除原发肿瘤的患者几乎占了一半，并且越来越多地在接受全身治疗后进行手术切除。在转移性乳腺癌的情况下，协调的多学科护理仍然是高度相关的，在这种情况下，手术决定应该根据个人情况做出，并可能影响某些妇女的生存。
We evaluated patterns of surgical care and their association with overall survival among a contemporary cohort of women with stage IV breast cancer. Surgical resection of the primary tumor remains controversial among women with stage IV breast cancer. Women diagnosed with clinical stage IV breast cancer from 2003 to 2012 were identified from the American College of Surgeons National Cancer Database. Those with intact primary tumors who were alive 12 months after diagnosis were categorized by treatment sequence: (1) surgery before systemic therapy, (2) systemic therapy before surgery, and (3) systemic therapy alone. Multivariate logistic regression was used to estimate the association of treatment sequence with surgery type. Overall survival was estimated using multivariate Cox proportional hazards models. Among 24,015 women, 56.2% (13,505) underwent systemic therapy alone and 43.8% (10,510) underwent surgical resection. Rates of surgery decreased slightly over time (43.1% in 2003 to 41.9% in 2011). Treatment with systemic therapy before surgery was associated with larger tumor size (median 4.5 vs 3.1 cm, P < 0.001) and receipt of mastectomy (81.4% vs 52.2%, P < 0.001) when compared to those who underwent surgery first. Receipt of surgery, whether before or after systemic therapy (Hazard Ratio, 0.68; 95% confidence interval, 0.62–0.73; Hazard Ratio, 0.56; 95% confidence interval, 0.52–0.61; P < 0.001), was independently associated with improved adjusted overall survival when compared to systemic therapy alone. Surgical resection of the primary tumor occurs in almost half of women with stage IV breast cancer alive 1 year after diagnosis, and is increasingly occurring after systemic therapy. Coordinated multidisciplinary care remains highly relevant in the setting of metastatic breast cancer, where surgical decisions should be made on an individual basis and may affect survival in select women.