Originally published as JCO Early Release 10.1200/JCO.2005.04.2226 on May 15 2006

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Complete Excision of Primary Breast Tumor Improves Survival of Patients With Metastatic Breast Cancer at Diagnosis

Elisabetta Rapiti, Helena M. Verkooijen, Georges Vlastos, Gerald Fioretta, Isabelle Neyroud-Caspar, André Pascal Sappino, Pierre O. Chappuis, Christine Bouchardy

From the Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva; and the Department of Obstetrics and Gynecology, Unit of Senology and Gynecologic Oncology, Service of Oncology, and Service of Medical Genetics, Geneva University Hospitals, Geneva, Switzerland

Address reprint requests to Christine Bouchardy, MD, Geneva Cancer Registry, 55, Bd de la Cluse, CH-1205 Geneva, Switzerland; e-mail: Christine.BouchardyMagnin{at}imsp.unige.ch

PURPOSE: Surgery of the primary tumor usually is not advised for patients with metastatic breast cancer at diagnosis because the disease is considered incurable. In this population-based study, we evaluate the impact of local surgery on survival of patients with metastatic breast cancer at diagnosis.

METHODS: We included all 300 metastatic breast cancer patients recorded at the Geneva Cancer Registry between 1977 and 1996. We compared mortality risks from breast cancer between patients who had surgery of the primary breast tumor to those who had not and adjusted these risks for other prognostic factors.

RESULTS: Women who had complete excision of the primary breast tumor with negative surgical margins had a 40% reduced risk of death as a result of breast cancer (multiadjusted hazard ratio [HR], 0.6; 95% CI, 0.4 to 1.0) compared with women who did not have surgery (P = .049). This mortality reduction was not significantly different among patients with different sites of metastasis, but in the stratified analysis the effect was particularly evident for women with bone metastasis only (HR, 0.2; 95% CI, 0.1 to 0.4; P = .001). Survival of women who had surgery with positive surgical margins was not different from that of women who did not have surgery.

CONCLUSION: Complete surgical excision of the primary tumor improves survival of patients with metastatic breast cancer at diagnosis, particularly among women with only bone metastases.

Supported by PROSPER Grant No. 323-3069350 from the Swiss National Science Foundation (H.M.V).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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