Abstract
The survival benefit from radiotherapy in stage IV breast cancer has not been fully evaluated. We investigated the survival benefit of radiotherapy after surgery in de novo stage IV breast cancer. Using a population-based database (the Surveillance, Epidemiology, and End Results database 18, 2010–2013), patients diagnosed with de novo stage IV breast cancer were divided into those undergoing surgery alone (no-radiotherapy group) and those undergoing surgery followed by radiotherapy (radiotherapy group). After propensity-score matching (PSM), the cancer-specific survival (CSS) rates were estimated. Multivariate analysis was performed to evaluate the prognostic value of radiotherapy on survival. After PSM, the 3-year CSS rates in the no-radiotherapy (n = 882) and radiotherapy (n = 882) groups were 57.1% and 70.9% (P < 0.001), respectively. On multivariate analysis, radiotherapy after surgery was a significant prognosticator (hazard ratio [HR] 0.572; 95% confidence interval [CI] 0.472–0.693, P < 0.001). Regardless of surgery type and lymph node involvement, the radiotherapy group showed significantly higher CSS rates. For patients who survived six months or more, radiotherapy after surgery demonstrated favorable prognosis compared to surgery alone (HR 0.593; 95% CI 0.479–0.733, P < 0.001). In conclusion, radiotherapy after surgery increased CSS rates in de novo stage IV breast cancer compared to surgery alone.
Highlights
Metastatic breast cancer is a systemic disease[1] and local treatments such as surgery or radiotherapy that are effective for early breast cancer are not sufficient for locally advanced or metastatic disease
There were 1325 patients in the no-radiotherapy group and 882 in the radiotherapy group
The exact site of radiotherapy was unavailable from the SEER database, there were significant differences between the two groups
Summary
Metastatic breast cancer is a systemic disease[1] and local treatments such as surgery or radiotherapy that are effective for early breast cancer are not sufficient for locally advanced or metastatic disease. As advances in systemic therapy have extended the life expectancy of metastatic breast cancer patients, the utility of local treatments has become a new question in de novo stage IV breast cancer patients[5]. Retrospective studies have shown that local treatments increase survival[12,13,14,15,16], recent randomized controlled trials that investigated the survival benefit of surgery of the primary site revealed mixed conclusions[17,18,19,20]. This study was not a comparison between only surgery and combination of surgery and radiotherapy
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