Impact of surgical resection of primary breast tumor in stage IV breast cancer on local control and survival

Abstract

629 Background: Treatment for women with Stage IV breast cancer and an intact primary tumor consists of systemic therapy; resection of the primary tumor (PT) is reserved for palliation only. Retrospective data from the National Cancer Database suggest that local control of the PT may improve survival. We now report the experience with such patients at the Lynn Sage Breast Center, to assess the impact of treating in-breast disease on cancer-related outcomes Methods: Women presenting with Stage IV disease and an intact PT were identified through a prospectively maintained database. Charts were reviewed for: surgical resection of primary tumor, systemic therapy, time to first progression, overall survival, and presence of chest wall disease at death or last follow-up. Statistical analysis was done using Fisher’s Exact Test and the Gehan-Wilcoxon Test. Results: 84 patients with Stage IV breast cancer and an intact PT were seen between 1985–2003 (mean age 58, range 30–88). 39 women had chest wall data at last follow-up or death (median follow-up 22 months). Of these, 20 women underwent surgical resection of the primary tumor, and four (20%) had a disease-free chest wall, compared to 15/19 (79%) who did not undergo resection of the primary tumor (O.R. 0.073; 95% C.I. 0.010, 0.384, p=0.0004). In addition, the Gehan-Wilcoxon test showed a significant difference in time to first progression for patients who underwent surgical resection of the PT (p=0.04). Kaplan-Meier curves demonstrate a median first progression time of 17 months for 43 patients in the resection group vs.11 months for 41 patients in the non-resection group. Overall survival was longer in those who had surgical resection of the PT (p=0.0122). Kaplan-Meier curves demonstrate a median survival time of 26 months for the 43 patients in the resection group and 16 months for the 41 patients in the non-resection group. Conclusions: Resection of the primary tumor in women with Stage IV breast cancer appears to protect against uncontrolled chest wall disease, with increased overall survival. However, these data do not overcome inherent selection biases for surgical treatment, and a prospective randomized trial is needed. No significant financial relationships to disclose.