By Shazia Qureshi
THE HAGUE, Netherlands -- September 11, 2008 -- In patients with primary metastatic breast cancer, surgical excision of the primary tumour was associated with a 31% reduction in mortality risk, researchers reported here at the 14th Congress of the European Society of Surgical Oncology (ESSO).
The association between primary tumour excision and reduced mortality risk was independent of age and comorbidity but "appeared to be stronger in patients with an isolated metastatic site," said lead author Jetske Ruiterkamp, MD, Jeroen Bosch Hospital, Den Bosch, Netherlands.
Dr. Ruiterkamp presented the results of this retrospective study on September 10.
For their study, Dr. Ruiterkamp and her colleagues identified 20,522 women who had been diagnosed with breast cancer in the southern Netherlands between 1975 and 2002. Within this group, metastatic disease was found at the time of initial presentation in 3.6% of patients.
Of the 728 women with metastatic disease, 440 patients (60%) were given palliative care only and 288 (40%) underwent surgical excision of the primary tumour.
The investigators performed metavariate analyses, adjusting the data for age, TNM Classification of Malignant Tumors (tumour/nodes/metastasis), localisation and number of metastases, and comorbidity.
Results showed that median survival was significantly longer in the surgery patients compared with the patients who had not undergone surgery (2.55 vs 1.17 years; P < .0001).
In addition, when the investigators controlled for potential confounders, they found that the surgery patients had a 31% lower mortality risk (hazard ratio 0.69). The reduction in mortality risk was less pronounced in patients with multiple metastases and comorbidity but it remained statistically significant.
A significant difference in median survival was also seen in women less than 50 years old. Median survival was 3.27 years in patients whose primary tumour had been surgically removed and 1.71 years in those who had not had surgery (P = .002).
The study also showed that 3 factors other than tumour excision surgery were significant independent prognostic covariates of improved prognosis. These included the age of the patient, the number of metastatic sites, and systemic therapy given to the patient.
Dr. Ruiterkamp said that the results of this retrospective study have encouraged her and her colleagues to start a randomised trial to test tumour surgery versus no surgery in patients with primary metastatic breast cancer.
[Presentation title: The Prognostic Significance of Tumor Surgery in Patients With Primary Metastatic Breast Cancer. Abstract 9]
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