Should breast surgery be considered for patients with de novo metastatic inflammatory breast cancer?

We aimed to identify factors predicting surgery for de novo stage IV inflammatory breast cancer (IBC) and determine the association of surgery with overall survival (OS). Female patients with unilateral AJCC clinical stage IV IBC treated 2010–2018 in the NCDB were identified. Logistic regression and...

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Bibliographic Details
Published in:The American journal of surgery 2024-07, Vol.233, p.52-60
Main Authors: Drapalik, Lauren M., Shenk, Robert, Rock, Lisa, Simpson, Ashley, Amin, Amanda L., Miller, Megan E.
Format: Article
Language:English
Subjects:
Breast cancer
Breast surgery
Cancer therapies
Chemotherapy
De novo metastatic breast cancer
Demographics
Family income
Hazard identification
Inflammation
Inflammatory breast cancer
Mastectomy
Medical prognosis
Metastases
Metastasis
Modified radical mastectomy
Overall survival
Patients
Radiation therapy
Regression analysis
Stage IV metastatic breast cancer
Statistical analysis
Surgery
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Summary:We aimed to identify factors predicting surgery for de novo stage IV inflammatory breast cancer (IBC) and determine the association of surgery with overall survival (OS). Female patients with unilateral AJCC clinical stage IV IBC treated 2010–2018 in the NCDB were identified. Logistic regression and multivariable proportional Cox hazards regressions determined factors associated with treatment and OS. Of 1049 patients, 29.1% underwent breast surgery (BS) and 70.9% had no surgery (NS). Increasing age and more recent treatment year were significantly associated with NS. 2-Year OS was superior in BS patients (71% vs 38% NS). Single-site and bone-only metastasis had no association with treatment type or OS. Contrary to guidelines, 1/3 of de novo stage IV IBC patients underwent BS, and had an independent OS benefit irrespective of extent or site of metastasis. Further research is needed to determine which patients with stage IV IBC should undergo BS. •Breast surgery for de novo stage IV breast cancer is contraindicated by guidelines.•Up to one-third of patients with de novo stage IV inflammatory breast cancer in a national cohort undergo this intervention.•Breast surgery was associated with an independent overall survival benefit irrespective of extent or site of metastasis.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2024.02.007