Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry)

Sara Lopez-Tarruella, M J Escudero, Marina Pollan, Miguel Martín, Carlos Jara, Begoña Bermejo, Angel Guerrero-Zotano, José García-Saenz, Ana Santaballa, Emilio Alba, Raquel Andrés, Purificación Martínez, Lourdes Calvo, Antonio Fernández, Norberto Batista, Antonio Llombart-Cussac, Antonio Antón, Ainhara Lahuerta, Juan de la Haba, José Manuel López-Vega, E Carrasco, Sara Lopez-Tarruella, M J Escudero, Marina Pollan, Miguel Martín, Carlos Jara, Begoña Bermejo, Angel Guerrero-Zotano, José García-Saenz, Ana Santaballa, Emilio Alba, Raquel Andrés, Purificación Martínez, Lourdes Calvo, Antonio Fernández, Norberto Batista, Antonio Llombart-Cussac, Antonio Antón, Ainhara Lahuerta, Juan de la Haba, José Manuel López-Vega, E Carrasco

Abstract

The debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach's outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990-2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study's criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.

Conflict of interest statement

Dr. López-Tarruella has consultancy/advisory role for AstraZeneca, Novartis, Roche, Pfizer, Celgene, Pierre-Fabre, Eisai and Lilly. Dr. García-Sáenz has received consultancy/speaker fees from Novartis, Celgene, Eli Lilly, EISAI and Roche. Travel support from Novartis, Roche as well as Pfizer and his institution’s research funding from AstraZeneca. Dr. Jara has received speaker fees from Roche, Pfizer, Eisai, Novartis and Kyowa as well as travel support from Roche and Pfizer. Dr. Martínez has received consultancy/speaker fees from Leo Pharma, AstraZeneca, Pfizer, and Tesaro as well as travel support from Roche, Rovi and Boehringer Ingelheim. Dr. Martín has a consultant or advisory role with AstraZeneca, Novartis, Roche-Genentech, Pfizer, Glaxo, PharmaMar, Taiho Oncology and Lilly; he has received honoraria from Pfizer and Lilly; he has received research funding from Novartis and Roche. Dr. Guerrero has received travel support from Pfizer. Dr. Antón has consultant/advisory role for Roche and Bayern. Dr. Carrasco has received travel support from Roche and her institution has received funding from Roche, Novartis, Pfizer, BMS, Celgene, AstraZeneca and MSD. Dr. Llombart has received honoraria from Roche, Lilly, Pfizer and Novartis; he has a consultant/advisory role for Roche; he has received funding from Roche, Eisai, AstraZeneca, Lilly and Pfizer and has stock ownership from MedSIR. The rest of the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patient selection flowchart.
Figure 2
Figure 2
Local and systemic treatments administered to de novo MBC patients and corresponding survival outcomes from El Álamo registry.
Figure 3
Figure 3
Overall survival for El Álamo registry patients. (a) Overall Survival for all de novo metastatic breast cancer patients; (b) Overall survival by surgery and no-surgery groups of the primary tumor.
Figure 4
Figure 4
Subgroup analysis of overall survival from El Álamo registry.

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Source: PubMed

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