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Survival benefit of a combined surgical approach in patients with metastatic breast cancer

Background We previously reported survival benefit of surgery in patients with stage IV breast cancer (BC); prospective trials yielded inconclusive results. Methods We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metasta...

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Published in:Journal of surgical oncology 2021-12, Vol.124 (8), p.1235-1241
Main Authors: Bilani, Nadeem, Yaghi, Marita, Singh Jabbal, Iktej, Elson, Leah, Elimimian, Elizabeth Blessing, Liang, Hong, Nahleh, Zeina
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container_issue 8
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container_title Journal of surgical oncology
container_volume 124
creator Bilani, Nadeem
Yaghi, Marita
Singh Jabbal, Iktej
Elson, Leah
Elimimian, Elizabeth Blessing
Liang, Hong
Nahleh, Zeina
description Background We previously reported survival benefit of surgery in patients with stage IV breast cancer (BC); prospective trials yielded inconclusive results. Methods We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metastasectomy. A multivariate Cox‐regression survival model investigated the overall survival (OS) of this surgical approach as compared to lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. The Kaplan–Meier method was used to demonstrate the utility of surgery when metastasis were confined to 1 site stratifying by tissue type. Results A total of n = 55,125 patients were included. As compared to lumpectomy/mastectomy alone (43 months), lumpectomy/mastectomy + metastasectomy exhibited the best OS (50 months, p = 0.012), metastasectomy alone showed slightly worse OS (30 months, p 
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Methods We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metastasectomy. A multivariate Cox‐regression survival model investigated the overall survival (OS) of this surgical approach as compared to lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. The Kaplan–Meier method was used to demonstrate the utility of surgery when metastasis were confined to 1 site stratifying by tissue type. Results A total of n = 55,125 patients were included. As compared to lumpectomy/mastectomy alone (43 months), lumpectomy/mastectomy + metastasectomy exhibited the best OS (50 months, p = 0.012), metastasectomy alone showed slightly worse OS (30 months, p < 0.0001), and no surgery had the worst OS (21 months, p < 0.0001). In metastasis confined to 1 site, superior OS with combined lumpectomy/mastectomy and metastasectomy versus lumpectomy/mastectomy alone was observed with liver (72.8 vs. 48.1 months, p < 0.001) or lung (49.2 vs. 36.8 months, p < 0.001) metastasis but not bone (52.2 vs. 49.9 months, p < 0.001) or brain (16.2 vs. 15.5 months, p < 0.001). Conclusion Patients with metastatic BC undergoing primary site resection and metastasectomy exhibited optimal OS, particularly when metastasis involved only the liver or lung.]]></description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.26656</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>Breast cancer ; breast neoplasms ; Lumpectomy ; Mastectomy ; medical oncology ; metastasectomy ; Metastasis ; registries ; Surgery</subject><ispartof>Journal of surgical oncology, 2021-12, Vol.124 (8), p.1235-1241</ispartof><rights>2021 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3306-d22c675c18714007ef7a26c60674c13c31fab3af091a2af2bb80f2ebe8da5c9b3</citedby><cites>FETCH-LOGICAL-c3306-d22c675c18714007ef7a26c60674c13c31fab3af091a2af2bb80f2ebe8da5c9b3</cites><orcidid>0000-0001-5818-7558 ; 0000-0002-7335-9319 ; 0000-0002-2489-1501</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Bilani, Nadeem</creatorcontrib><creatorcontrib>Yaghi, Marita</creatorcontrib><creatorcontrib>Singh Jabbal, Iktej</creatorcontrib><creatorcontrib>Elson, Leah</creatorcontrib><creatorcontrib>Elimimian, Elizabeth Blessing</creatorcontrib><creatorcontrib>Liang, Hong</creatorcontrib><creatorcontrib>Nahleh, Zeina</creatorcontrib><title>Survival benefit of a combined surgical approach in patients with metastatic breast cancer</title><title>Journal of surgical oncology</title><description><![CDATA[Background We previously reported survival benefit of surgery in patients with stage IV breast cancer (BC); prospective trials yielded inconclusive results. Methods We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metastasectomy. A multivariate Cox‐regression survival model investigated the overall survival (OS) of this surgical approach as compared to lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. The Kaplan–Meier method was used to demonstrate the utility of surgery when metastasis were confined to 1 site stratifying by tissue type. Results A total of n = 55,125 patients were included. As compared to lumpectomy/mastectomy alone (43 months), lumpectomy/mastectomy + metastasectomy exhibited the best OS (50 months, p = 0.012), metastasectomy alone showed slightly worse OS (30 months, p < 0.0001), and no surgery had the worst OS (21 months, p < 0.0001). In metastasis confined to 1 site, superior OS with combined lumpectomy/mastectomy and metastasectomy versus lumpectomy/mastectomy alone was observed with liver (72.8 vs. 48.1 months, p < 0.001) or lung (49.2 vs. 36.8 months, p < 0.001) metastasis but not bone (52.2 vs. 49.9 months, p < 0.001) or brain (16.2 vs. 15.5 months, p < 0.001). Conclusion Patients with metastatic BC undergoing primary site resection and metastasectomy exhibited optimal OS, particularly when metastasis involved only the liver or lung.]]></description><subject>Breast cancer</subject><subject>breast neoplasms</subject><subject>Lumpectomy</subject><subject>Mastectomy</subject><subject>medical oncology</subject><subject>metastasectomy</subject><subject>Metastasis</subject><subject>registries</subject><subject>Surgery</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp10E1LAzEQBuAgCtbqwX8Q8KKHbSfZ3ezmKMVPCj1UL15CkiY2Zb9Mdlv6702tJ8FThswzw_AidE1gQgDodBPaCWUsZydoRICzhAMvT9Eo9miSFRzO0UUIGwDgnGUj9LEc_NZtZYWVaYx1PW4tlli3tXKNWeEw-E-nY1t2nW-lXmPX4E72zjR9wDvXr3Ftehn6-KWx8iaWWMtGG3-Jzqysgrn6fcfo_fHhbfaczBdPL7P7eaLTFFiyolSzItekLEgGUBhbSMo0A1ZkmqQ6JVaqVFrgRFJpqVIlWGqUKVcy11ylY3R73BsP_BpM6EXtgjZVJRvTDkHQnDFIOc1opDd_6KYdfBOvi4pHlWX0oO6OSvs2BG-s6Lyrpd8LAuKQsogpi5-Uo50e7c5VZv8_FK_LxXHiG3m6fsU</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Bilani, Nadeem</creator><creator>Yaghi, Marita</creator><creator>Singh Jabbal, Iktej</creator><creator>Elson, Leah</creator><creator>Elimimian, Elizabeth Blessing</creator><creator>Liang, Hong</creator><creator>Nahleh, Zeina</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5818-7558</orcidid><orcidid>https://orcid.org/0000-0002-7335-9319</orcidid><orcidid>https://orcid.org/0000-0002-2489-1501</orcidid></search><sort><creationdate>20211201</creationdate><title>Survival benefit of a combined surgical approach in patients with metastatic breast cancer</title><author>Bilani, Nadeem ; Yaghi, Marita ; Singh Jabbal, Iktej ; Elson, Leah ; Elimimian, Elizabeth Blessing ; Liang, Hong ; Nahleh, Zeina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3306-d22c675c18714007ef7a26c60674c13c31fab3af091a2af2bb80f2ebe8da5c9b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Breast cancer</topic><topic>breast neoplasms</topic><topic>Lumpectomy</topic><topic>Mastectomy</topic><topic>medical oncology</topic><topic>metastasectomy</topic><topic>Metastasis</topic><topic>registries</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bilani, Nadeem</creatorcontrib><creatorcontrib>Yaghi, Marita</creatorcontrib><creatorcontrib>Singh Jabbal, Iktej</creatorcontrib><creatorcontrib>Elson, Leah</creatorcontrib><creatorcontrib>Elimimian, Elizabeth Blessing</creatorcontrib><creatorcontrib>Liang, Hong</creatorcontrib><creatorcontrib>Nahleh, Zeina</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bilani, Nadeem</au><au>Yaghi, Marita</au><au>Singh Jabbal, Iktej</au><au>Elson, Leah</au><au>Elimimian, Elizabeth Blessing</au><au>Liang, Hong</au><au>Nahleh, Zeina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival benefit of a combined surgical approach in patients with metastatic breast cancer</atitle><jtitle>Journal of surgical oncology</jtitle><date>2021-12-01</date><risdate>2021</risdate><volume>124</volume><issue>8</issue><spage>1235</spage><epage>1241</epage><pages>1235-1241</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract><![CDATA[Background We previously reported survival benefit of surgery in patients with stage IV breast cancer (BC); prospective trials yielded inconclusive results. Methods We sampled the National Cancer Database (2004–2016) for de novo stage IV BC patients undergoing both primary site resection and metastasectomy. A multivariate Cox‐regression survival model investigated the overall survival (OS) of this surgical approach as compared to lumpectomy/mastectomy alone, metastasectomy alone, or no surgery. The Kaplan–Meier method was used to demonstrate the utility of surgery when metastasis were confined to 1 site stratifying by tissue type. Results A total of n = 55,125 patients were included. As compared to lumpectomy/mastectomy alone (43 months), lumpectomy/mastectomy + metastasectomy exhibited the best OS (50 months, p = 0.012), metastasectomy alone showed slightly worse OS (30 months, p < 0.0001), and no surgery had the worst OS (21 months, p < 0.0001). In metastasis confined to 1 site, superior OS with combined lumpectomy/mastectomy and metastasectomy versus lumpectomy/mastectomy alone was observed with liver (72.8 vs. 48.1 months, p < 0.001) or lung (49.2 vs. 36.8 months, p < 0.001) metastasis but not bone (52.2 vs. 49.9 months, p < 0.001) or brain (16.2 vs. 15.5 months, p < 0.001). Conclusion Patients with metastatic BC undergoing primary site resection and metastasectomy exhibited optimal OS, particularly when metastasis involved only the liver or lung.]]></abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/jso.26656</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5818-7558</orcidid><orcidid>https://orcid.org/0000-0002-7335-9319</orcidid><orcidid>https://orcid.org/0000-0002-2489-1501</orcidid></addata></record>
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subjects Breast cancer
breast neoplasms
Lumpectomy
Mastectomy
medical oncology
metastasectomy
Metastasis
registries
Surgery
title Survival benefit of a combined surgical approach in patients with metastatic breast cancer
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