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| |  LSBCS: Removal of Primary Tumour Improves Survival in Stage IV Breast Cancer By W. A. Thomasson, PhD CHICAGO, IL -- October 2, 2003 -- Removal of the primary tumour improves survival in Stage IV metastatic breast cancer, contrary to current belief, according to a study presented here September 20th at the 5th Annual Lynn Sage Breast Cancer Symposium. The study's findings were in accord with those from retrospective studies in gastric and colorectal cancer, as well as a prospective study in renal-cell carcinoma conducted by the Southwest Oncology Group. Seema Kahn, MD, Northwestern University Medical School, Chicago, Illinois, United States, and colleagues there and at the American College of Surgeons, also in Chicago, noted that their results are in accord with those they themselves reached previously using a different cohort. The current study used data from the American College of Surgeons' National Cancer Data Base and included all 9,478 women diagnosed with stage IV breast cancer in 1994 or 1995. The entire cohort was analysed for type of surgery (none, partial mastectomy, complete mastectomy) and systemic therapy. Absence of surgery was found to be associated with higher T-score and greater number of metastatic sites. Furthermore, graphs of survival over a 5-year period showed clear differences between surgery and no surgery, with a small advantage for complete mastectomy. The most interesting analysis, however, was of mortality in women for whom data on surgical margins were available. The three groups compared were 3,594 patients who received biopsy alone or no surgery at all, 1,168 who underwent surgery that left involved margins, and 1,879 with disease-free margins. Results were particularly striking for 3-year survival, which was 17.7% among those without surgery, 25.6% for those with involved surgical margins, and 31.7% for those with disease-free margins. After adjusting for age, number of metastatic sites, visceral versus soft-tissue or bony metastases, and systemic therapy, the relative risk compared to no surgery was 0.68 (95% confidence interval [CI] 0.64 0.72) for those with disease-free margins and 0.75 (95% CI 0.69 0.81) for those with involved margins. There were also notable differences in median survival (10.3 months without surgery, 13.8 months with disease-free margins) and 5-year survival (6.5% and 12.8%, respectively). The authors speculated that improved survival may in part result from a reduced risk of uncontrolled chest-wall disease, although this cannot be concluded from the data. They also noted the limitations of retrospective studies, such as possible associations between use of surgery and unrecognised variables that independently affect survival. Nevertheless, the authors concluded, "The hypothesis generated by these retrospective reviews deserves to be tested in a prospective trial where women with Stage IV disease and intact primaries are randomly allocated to systemic therapy versus systemic therapy plus treatment of the intact primary tumour."
[Study title: "Does Local Therapy of the Intact Primary Tumor in Stage 4 Breast Cancer Affect Survival?" Abstract D7]
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