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Minerva Ginecologica 2018 February;70(1):44-52

DOI: 10.23736/S0026-4784.17.04097-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Increasing survival of metastatic breast cancer through locoregional surgery

Begoña DÍAZ de la NOVAL 1 , Laura FRÍAS ALDEGUER 2, María ÁNGELES LEAL GARCÍA 2, Enrique GARCÍA LÓPEZ 2, Mariana DÍAZ ALMIRÓN 3, María HERRERA de la MUELA 2

1 Unit of Gynecology Oncology, Department of Gynecology and Obstetrics, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain; 2 Multidisciplinary Unit of Breast Disease, Department of Gynecology and Obstetrics, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain; 3 Department of Biostatistics, Research Institute (IdiPAZ), Madrid, Spain


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BACKGROUND: Surgery for the primary tumor in metastatic breast cancer is usually not recommended, assuming that local therapy provides no advantage. Recent reports suggest a survival improvement after locoregional treatment, but this is still controversial. We aimed to evaluate the effectiveness of locoregional treatment in primary metastatic breast cancer and to determine associated factors.
METHODS: A retrospective analysis of 39 women with de-novo metastatic breast cancer at La Paz University Hospital, from January 2012 to June 2016, grouped by locoregional treatment (n=23) or not (n=16). Multivariate assessment of prognostic factors was performed using Cox regression analysis.
RESULTS: Mean tumor size was 6 cm. Eighteen patients (46.2%) had multifocal tumors, 29 (74.4%) multicentric and 10 (25.7%) bilateral breast cancer. Eighteen patients (46.2%) had an oligometastatic disease and 21 (53.8%) multiorgan metastatic disease. The average time from diagnosis to surgery was 7.7 months, without delay in the start of systemic treatment compared to the no-surgery group. The main surgical procedure was mastectomy in 18 (78.3%) patients. Half of the patients survived 48 months (95% CI: 39-57). In the multivariate analysis, we have not detailed differences in survival by age, chemotherapy, neoadjuvancy, number of systemic treatment lines, radiotherapy, and tumor histology or grade. However, surgery (HR=0.2; 95% CI: 0.07-0.57) and high tumor burden (HR=2.96, 95% CI: 1.23-7.13) have acted as a protective and a risk factor respectively.
CONCLUSIONS: Our cohort supports that locoregional treatment in selected patients with de-novo MBC significantly improved survival, so it might be considered in combination with systemic therapy.


KEY WORDS: Breast neoplasms - Segmental mastectomy - Survival analysis - Tumor burden

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