医学
外科肿瘤学
乳腺癌
阶段(地层学)
内科学
肿瘤科
原发性肿瘤
妇科
普通外科
外科
癌症
回顾性队列研究
乳房切除术
作者
Yunfang Yu,Huangming Hong,Ying Wang,Tuping Fu,Yongjian Chen,Jianli Zhao,Peixian Chen,Ruizhao Cai,Yujie Tan,Zifan He,Wei Ren,Li-Huan Zhou,Jun-Hao Huang,Jun Tang,Guolin Ye,Herui Yao
标识
DOI:10.1245/s10434-021-09650-3
摘要
Whether primary tumor surgery is better than no surgery in patients with de novo stage IV breast cancer remains controversial. This study combined prospective clinical trials and a multicenter cohort to evaluate the impact of locoregional surgery in de novo stage IV breast cancer. The GRADE approach was used to assess the quality of evidence in meta-analysis, and propensity score matching analysis was used in the cohort study. This study was registered with PROSPERO CRD42016043766 and ClinicalTrials.gov NCT04456855. A total of 1110 patients from six trials and 353 patients from the cohort study were included. The meta-analysis showed that compared with no surgery, locoregional surgery did not prolong overall survival (hazard ratio [HR] = 0.90, P = 0.40; moderate-quality) but had a significantly longer locoregional progression-free survival (HR = 0.23, P < 0.001; moderate-quality). The subgroup analysis of solitary bone-only metastasis (HR = 0.47, P = 0.04; high-quality) resulted in prolonged overall survival. In the cohort study, locoregional surgery showed a survival benefit (HR = 0.63, P = 0.041) before matching, but not (HR = 0.84, P = 0.579) after matching. Patients with bone-only metastasis showed a survival advantage in surgery compared with no surgery before matching (HR = 0.36, P = 0.034) as well as after matching (HR = 0.18, P = 0.017). This study indicated that locoregional surgery had a significantly longer locoregional progression-free survival than no surgery in de novo stage IV breast cancer, and patients with bone-only metastasis tended to show an overall survival benefit from surgery.
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