American journal of surgery | 2021
Metastatic breast cancer: Who benefits from surgery?
Abstract
BACKGROUND\nWe sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection.\n\n\nMETHODS\nRecursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models.\n\n\nRESULTS\nAll patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p\xa0<\xa00.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups.\n\n\nCONCLUSION\nPrognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.