Can surgery enhance survival rates in metastatic breast cancer?

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