368P - Is Surgery of the Primary Tumor Convenient in Metastatic Breast Cancer?

Abstract

ABSTRACT Introduction Stage IV breast cancer is treated primarily with systemic therapies. Excision of the primary breast cancer tumor in presence of synchronous distant metastases is a controversial argument, and a standard recommendation is not proposed by current guidelines. We performed a meta-analysis with the aim of pooling the existing survival data of surgery of the breast primary tumor in stage IV disease. Materials and methods We searched PubMed for publications including female, with histologically confirmed stage IV breast cancer at presentation and an intact primary tumor. Primary outcome was overall survival (OS) in patients treated with resection of primary breast cancer in presence of synchronous distant metastases. Secondary endpoints were PFS or TTP (and local and/or distant PFS or TTP, whichever reported). Hazard ratios (HRs) for survival when reported after multivariate analysis (with 95% confidence intervals) were obtained from publications and aggregated in a meta-analysis. A meta-regression weighted for extent of disease, ER/HER2 status, age, visceral or bone disease, rate of radiotherapy, and systemic therapies offered was also performed. Results 15 articles were included in this meta-analysis (all retrospective case series), for a total of 15.378 patients. Surgery of the primary breast cancer appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with an HR of 0.69 (p Conclusions Our pooled-analysis, reveals that surgery of an intact primary tumor, although associated with distant metastases, reduces the risk of death by 30%. This results are particular significant if local surgery is associated with systemic therapy and radiotherapy into a multimodality strategy. The surgical excision of a primary breast cancer in patients with stage IV disease – if feasible - should be discussed with and proposed to patients. Disclosure All authors have declared no conflicts of interest.