Can surgery enhance survival rates in metastatic breast cancer?

A recent review published in The Oncologist showed that surgery of the primary breast tumor in patients with de novo metastatic breast cancer does not significantly prolong overall survival, except for potential benefits in younger/premenopausal individuals, highlighting the need for further clinical trials to guide decision-making.

The research team meticulously analyzed data from multiple sources, including the Cochrane Library, Embase, Medline (OVID), and Web of Science, with the latest update in July 2023. They also manually searched conference proceedings for relevant information.

Out of 3255 identified entries, only five RCTs met the rigorous inclusion criteria, encompassing a total of 1381 patients. Overall, the analysis showed that surgical excision of the primary breast tumor did not confer a survival advantage (HR = 0.93; 95% CI, 0.76-1.14) in the intention-to-treat population.

Subgroup analyses, based on receptor status or patterns of metastasis, failed to demonstrate significant benefits, except for one group— younger/premenopausal patients (HR = 0.74, 95% CI, 0.58-0.94). Intriguingly, breast surgery did prove advantageous for local progression-free survival (HR = 0.37, 95% CI, 0.19-0.74).

The comprehensive findings highlight the nuanced nature of decision-making in cases of de novo MBC. While breast surgery may not universally extend patient survival, it could hold promise for specific demographics, such as younger or premenopausal individuals.

Reference: Guillermo Villacampa, Andri Papakonstantinou, Irma Fredriksson, Alexios Matikas, Impact of Primary Breast Surgery on Overall Survival of Patients With De Novo Metastatic Breast Cancer: A Systematic Review and Meta-Analysis, The Oncologist, 2023, oyad266, https://doi.org/10.1093/oncolo/oyad266