Source: DGNews  |  Posted 2 years ago

By Gabe Waggoner

PHOENIX, Ariz -- March 7, 2009 -- Local surgery on the tumours of patients with metastatic breast cancer appears to significantly reduce the risk of death, according to findings presented at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium.

Jetske Ruiterkamp, MD, Jeroen Bosch Hospital, ‘s-Hertogenbosch, Netherlands, and colleagues retrospectively studied patients with stage IV primary metastatic breast cancer to determine whether local surgery on the tumour affected patient survival.

“Because metastatic breast cancer is considered to be an incurable disease, it is treated palliatively,” Dr. Ruiterkamp said in a breast cancer session here on March 6. She also pointed out that operating locally on the primary tumour is advised only if the tumour is symptomatic.

The research team identified 20,000 patients who had been diagnosed with breast cancer in the south of the Netherlands between 1975 and 2002. Five percent of this group suffered from metastatic disease at initial presentation. The authors conducted multivariate analyses to compare survival differences between patients who underwent local surgery and those who did not. The researchers also adjusted for age, classification in the tumour-node-metastasis system, the localisation and number of metastatic sites, and comorbidity.

A total of 288 of the 728 identified patients had their primary tumours removed with local surgery. The authors found that patients who had undergone surgery survived longer than patients who had not (2.55 versus 1.17 years, respectively; P < .0001). Factors that contributed significantly to a better outlook included surgery, age, the number of sites of metastasis, and treatment with systemic therapy.

Patients whose tumours are surgically removed were at less risk of dying (hazard ratio of 0.69 after control for potential confounders). Dr. Ruiterkamp also said that surgical removal of the primary tumour still contributed significantly to the survival of patients with multiple metastases and comorbidity, albeit not as effectively as in patients with only 1 isolated metastatic site.

Dr. Ruiterkamp said that approximately 1 in 9 women in the Netherlands is diagnosed with breast cancer each year, 3% to 10% of whom present with disease that has metastasised.

“Local surgery of the tumour in patients with primary metastatic breast cancer is associated with a significant reduction of the mortality risk,” Dr. Ruiterkamp concluded. She also indicated that more research was needed, and urged that a randomised, controlled trial be conducted to exclude other potential confounders.

[Presentation title: The Prognostic Significance of Tumor Surgery in Patients With Primary Metastatic Breast Cancer. Abstract 18]