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Removing Stage IV Primary May Cut Mortality

Removing Stage IV Primary May Cut Mortality

WASHINGTON—Removal of the primary breast tumor in patients with stage IV breast cancer was associated with significantly longer survival, according to an analysis of the 1988-2003 Surveillance Epidemiologic End Results (SEER) data reported by Jennifer L. Gnerlich, MD, at the Society for Surgical Oncology (SSO) 60th Annual Meeting (abstract 54). Dr. Gnerlich is a surgical resident at Washington University School of Medicine, St. Louis, Missouri. Senior author is Julie Margenthaler, MD, assistant professor of surgery at Washington University.

The retrospective, population-based cohort study compared survival of 9,734 women with stage IV breast cancer who underwent surgical excision of their primary tumor (n = 4,578) with survival of women who did not have surgery (n = 5,156).

Dr. Gnerlich reported that 24% of women who had surgery and 16% of women who did not have surgery were still alive at follow-up. After controlling for potential confounding variables and propensity scores, median survival was 36 months with surgery vs 21 months without surgery for those still alive at follow-up (P < .0001), and 18 vs 7 months for those who had died by the time of follow-up (P <. 0001).

The adjusted hazard ratio (HR) for death during follow-up was 0.63 (95% CI 0.60 to 0.66) for those patients who had surgery, indicating that the patients who underwent surgery were 37% less likely to die during the study period.

Dr. Gnerlich stressed that "this is a retrospective, population-based cohort study and should be interpreted with caution." Randomized prospective trials are necessary to further evaluate if women with stage IV breast cancer truly do have a survival advantage, she said, "and to determine which women with stage IV breast cancer will benefit most from surgery."

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