Stage IV Breast Cancer: Can Surgery Improve Survival?
"New research suggests locoregional treatment may offer hope for Chinese women with de novo stage IV breast cancer."
Breast cancer remains a significant health challenge for women worldwide. While advancements in chemotherapy, targeted therapies, and endocrine treatments have extended survival for those with stage IV disease (where the cancer has already spread to other parts of the body at diagnosis), the optimal treatment approach remains a subject of ongoing research. Traditionally, systemic therapies have been the cornerstone of care, but recent studies are exploring the role of local treatments like surgery and radiotherapy.
Approximately 5-10% of patients discover they have stage IV breast cancer when they are first diagnosed. For these individuals, the median survival time has historically been limited to 18-24 months. However, innovations continue, aiming to improve both longevity and quality of life.
Now, a retrospective study focuses specifically on Chinese women with de novo stage IV breast cancer, investigating whether locoregional treatment—surgery to remove the primary tumor and/or radiotherapy—can make a difference in their prognosis. The study seeks to determine if these local interventions, in addition to standard systemic therapies, can offer a survival advantage.
Does Removing the Primary Tumor Help?
The study, published in Gynecologic and Obstetric Investigation, retrospectively analyzed data from 157 Chinese women diagnosed with de novo stage IV breast cancer between 2001 and 2016. Researchers at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College divided participants into two groups: those who underwent surgery to remove the primary breast tumor and those who did not. They then compared overall survival (OS) and distant progression-free survival (DPFS) between the groups.
- Surgery Linked to Improved Survival: Patients in the surgery group demonstrated longer 5-year overall survival and 5-year distant progression-free survival compared to those who did not undergo surgery.
- Radiotherapy Also Beneficial: Distant progression-free survival was significantly longer in patients who received locoregional radiotherapy.
- Factors Associated with Survival: Response to systemic therapy and surgical treatment were both independently associated with improved survival outcomes.
- Progesterone Receptor Status Matters: Multivariate analysis revealed that progestogen receptor status significantly influenced distant progression-free survival.
What Does This Mean for Breast Cancer Treatment?
This study adds to the growing body of evidence suggesting that, in some cases, local treatment of the primary tumor can improve outcomes for patients with stage IV breast cancer. While the study is limited by its retrospective nature and specific focus on a Chinese population, it highlights the potential importance of carefully considering locoregional approaches in treatment planning.
The researchers emphasize that surgical resection should be reserved for carefully selected patients – those with a lower disease burden, a good response to systemic treatment, and a desire to manage potential local complications. More randomized controlled trials are needed to confirm these findings and better define the optimal role of surgery and radiotherapy in stage IV breast cancer management.
Ultimately, the goal is to personalize treatment strategies, incorporating both systemic and local therapies to maximize survival and quality of life for all individuals facing this challenging diagnosis. Further research into genetic factors might also play a vital role in future treatments.