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MINERVA GINECOLOGICA

A Journal on Obstetrics and Gynecology


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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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Publication History

Issue published online: January 4, 2018
Article first published online: October 9, 2017
Manuscript accepted: October 5, 2017
Manuscript received: May 30, 2017

Cite this article as

Díaz de la Noval B, Frías Aldeguer L, Ángeles Leal García M, García López E, Díaz Almirón M, Herrera de la Muela M. Increasing survival of metastatic breast cancer through locoregional surgery. Minerva Ginecol 2018;70:44-52. DOI: 10.23736/S0026-4784.17.04097-7

Corresponding author e-mail

begodelanoval@gmail.com