Clinical Evidence for Locoregional Surgery of the Primary Tumor in Patients with De Novo Stage IV Breast Cancer
Clinical Evidence for Locoregional Surgery of the Primary Tumor in Patients with De Novo Stage IV Breast Cancer
复制标题
新发 IV 期乳腺癌患者原发肿瘤局部手术的临床证据
DOI：
10.1245/s10434-021-09650-3
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发表时间：
2021-02-03
影响因子：
3.7
通讯作者：
Yao, Herui
中科院分区：
文献类型：
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作者：
Yu, Yunfang;Hong, Huangming;Yao, Herui
BackgroundWhether原发性肿瘤手术是不是比没有手术的患者，原发性IV期乳腺癌仍然存在争议。MethodsThis study combined prospective clinical trials and a multicenter cohort to evaluate impact of locoregional surgery in de novo stage IV breast cancer. Meta分析采用GRADE方法评价证据质量，队列研究采用倾向评分匹配分析。本研究在PROSPERO CRD 42016043766和ClinicalTrials.gov NCT 04456855中注册。结果共纳入来自6项试验的1110例患者和来自队列研究的353例患者。荟萃分析显示，与不手术相比，局部手术并没有延长总生存期（风险比[HR] = 0.90，P = 0.40;中等质量），但局部无进展生存期显著延长（HR = 0.23，P <0.001;中等质量）。孤立性骨转移的亚组分析（HR = 0.47，P = 0.04;高质量）导致总生存期延长。在队列研究中，匹配前局部手术显示出生存获益（HR = 0.63，P = 0.041），但匹配后无此获益（HR = 0.84，P = 0.579）。与匹配前未手术相比，仅骨转移的患者在手术中表现出生存优势（HR = 0.36，P = 0.034）与配对后相比（HR = 0.18，P = 0.017）。结论本研究表明，在原发性IV期乳腺癌中，局部手术治疗的局部无进展生存期明显长于不手术治疗，只有骨转移的患者倾向于显示手术的总体生存益处。
BackgroundWhether primary tumor surgery is better than no surgery in patients with de novo stage IV breast cancer remains controversial.MethodsThis study combined prospective clinical trials and a multicenter cohort to evaluate the impact of locoregional surgery in de novo stage IV breast cancer. The GRADE approach was used to assess the quality of evidence in meta-analysis, and propensity score matching analysis was used in the cohort study. This study was registered with PROSPERO CRD42016043766 and ClinicalTrials.gov NCT04456855.ResultsA total of 1110 patients from six trials and 353 patients from the cohort study were included. The meta-analysis showed that compared with no surgery, locoregional surgery did not prolong overall survival (hazard ratio [HR] = 0.90,P= 0.40; moderate-quality) but had a significantly longer locoregional progression-free survival (HR = 0.23,P <0.001; moderate-quality). The subgroup analysis of solitary bone-only metastasis (HR = 0.47,P= 0.04; high-quality) resulted in prolonged overall survival. In the cohort study, locoregional surgery showed a survival benefit (HR = 0.63,P= 0.041) before matching, but not (HR = 0.84,P= 0.579) after matching. Patients with bone-only metastasis showed a survival advantage in surgery compared with no surgery before matching (HR = 0.36,P= 0.034) as well as after matching (HR = 0.18,P= 0.017).ConclusionsThis study indicated that locoregional surgery had a significantly longer locoregional progression-free survival than no surgery in de novo stage IV breast cancer, and patients with bone-only metastasis tended to show an overall survival benefit from surgery.