Effect of local surgery on outcomes of stage IV breast cancer

• Published in: Translational cancer research 2020-08, Vol.9 (8), p.5102-5107
• Main Authors: Tsukioki, Takahiro, Shien, Tadahiko, Doihara, Hiroyoshi
• Format: Article
• Language: English
• Subjects: Review on Loco-regional Therapy for Metastatic Breast Cancer
• ISSN: 2218-676X; 2219-6803
• DOI: 10.21037/tcr.2020.01.60

Metastatic breast cancer (MBC), including stage IV, is regarded as being incurable and the mainstay of clinical management is systemic therapy. Traditionally, locoregional surgery is performed only for local control, such as to prevent ulceration and bleeding. In recent years, however, both retrospective and prospective studies have demonstrated the prognostic efficacy of primary surgery for stage IV patients. Therefore, we conducted a meta-analysis to evaluate whether surgical therapy contributes to overall survival (OS) extension. We searched for clinical trials published in electronic databases (PubMed, Embase, and the Cochrane databases) and performed a meta-analysis of the data collected. There were five prospective randomized controlled phase III trials (RCTs). The results of three have been reported. According to our meta-analysis of these RCTs, primary surgery for stage IV breast cancer patients significantly improves OS. However, the Tata trial showed that systemic therapy does not achieve a sufficient effect. Another trial, conducted in Turkey, had statistical shortcomings and patient randomization was not adequately performed The ABCSG (Austrian Breast and Colorectal Cancer Study Group) trial had too few subjects. Meta-analysis of 12 retrospective studies showed that patients with stage IV breast cancer receiving surgery as the initial treatment experienced longer OS (HR: 0.65, P