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."
