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J BUON. 2019 Mar-Apr;24(2):543-548.

Surgery in initially metastatic breast cancer: prognosis is associated with patient characteristics and timing of surgery.

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Department of Anesthesiology, the First Affiliated Hospital of Sun Yat-sen University, Guangdong, China.



The role of surgery in patients with initially metastatic breast cancer (IMBC) is unclear. The purpose of this study was to determine if surgery improves the prognosis of patients with IMBC.


Data of patients with IMBC at the First Affiliated Hospital of Sun Yat-Sen University from 2000 to 2014 were retrospectively analyzed. The last follow-up was October 2015. Clinical characteristics and overall survival (OS) were compared and evaluated by univariate and multivariate analysis.


Eighty-one patients were included in this study; 59 were operated and 22 were not. The median survival time was 28 months, 3-year survival rate was 32.5%, and 5-year survival rate was 8.4%. The OS of operated patients was significantly longer than those without surgery (34 vs. 23 months, p=0.002). Surgery (estimated hazard ratio [HR] =0.12, 95% confidence interval [CI]: 0.04-0.42) and endocrine therapy (HR=0.17, 95% CI: 0.06-0.54), were significantly associated with a better prognosis in the multivariate model. However, patients with surgery were younger, had fewer metastases, and a higher ratio of patients with Ki-67≤14%. Patients who were operated more than 3 months after diagnosis had better OS that those who had surgery less than 1 month (p=0.009). Stratified analyses of the surgery group found that younger age (HR 0.28, p=0.016), bone-only metastases (HR 0.24, p=0.006) and chemotherapy administration (HR 0.38, p=0.004) or endocrine therapy (HR 0.06, p=0.006) were favorable predictors of survival. Conclusion Surgery may prolong the OS of patients with IMBC, especially in certain of them, and in those who undergo surgery at a certain time.

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