Abstract
BackgroundThe impact of primary site surgery on survival remains controversial in female patients with stage IV breast cancer. The purpose of this study was to investigate the role of primary tumor surgery in patients with stage IV breast cancer and concurrently develop a nomogram to identify which patients will benefit from surgery.MethodsWe retrospectively searched the SEER database for female patients newly diagnosed with stage IV breast infiltrating duct carcinoma (BIDC) between 2010 and 2015 and then divided them into surgery and non-surgery groups. The propensity score matching (PSM) method was implemented to eliminate the bias, and Kaplan–Meier survival analysis was generated to compare the overall survival (OS) and cancer-specific survival (CSS) between the two groups. After PSM, Cox regression analyses were performed to determine the independent protective value of primary tumor surgery, while logistic regression analyses were utilized to uncover significant predictors of surgical benefit and establish a screening nomogram for female patients with stage IV BIDC. Nomogram performance was evaluated by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).Result5,475 patients with stage IV BIDC were included in this study, and 2,375 patients (43.38%) received primary tumor surgery. After PSM, the median CSS was 53 months (95% CI: 46.84–59.16) in the surgery group compared with only 33 months (95% CI: 30.05–35.95) in the non-surgery group. We further found that primary tumor surgery was an independent protective factor for patients with stage IV BIDC. The independent factors affecting the benefit of locoregional surgery in patients with stage IV BIDC included histological grade, T stage, molecular subtype, lung metastasis, liver metastasis, brain metastasis, and marital status. The AUC of the nomogram was 0.785 in the training set and 0.761 in the testing set. The calibration curves and DCA confirmed that the nomogram could precisely predict the possibility of benefit from primary tumor resection.ConclusionOur study suggested that primary tumor surgery improved the prognosis of female patients with stage IV BIDC and developed a nomogram to quantify the probability of surgical benefit to help identify surgical candidates clinically.
Highlights
Breast cancer (BC) is a common malignant tumor and the second most common cause of cancer death among women in the United States [1]
It is of great importance to clarify the effect of primary tumor resection on the survival of female patients with stage IV BC and develop a novel model to quantify the probability of surgical benefit to help identify surgical candidates clinically
6%–10% of female patients were diagnosed with stage IV BC [18], and about 20%–30% of early-stage patients would develop distant metastasis [21]
Summary
Breast cancer (BC) is a common malignant tumor and the second most common cause of cancer death among women in the United States [1]. Approximately 25%–30% of earlystage BC metastasizes and progresses to advanced BC, which is the leading cause of death from BC [6], and only 24%–26.5% of patients with stage IV BC survive for more than 5 years [7, 8]. The efficacy of surgical resection of the primary site in patients with stage IV BC remains controversial. It is of great importance to clarify the effect of primary tumor resection on the survival of female patients with stage IV BC and develop a novel model to quantify the probability of surgical benefit to help identify surgical candidates clinically. The impact of primary site surgery on survival remains controversial in female patients with stage IV breast cancer. The purpose of this study was to investigate the role of primary tumor surgery in patients with stage IV breast cancer and concurrently develop a nomogram to identify which patients will benefit from surgery
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