The American Society of Breast Surgeons Factors associated with improved outcome after surgery in metastatic breast cancer patients Kandace P. McGuire, M.D.*, Sarah Eisen, B.S., Amilcar Rodriguez, B.S., Tammi Meade, B.S., Charles E. Cox, M.D., Nazanin Khakpour, M.D. Moffitt Cancer Center, 12901 Magnolia Dr., Tampa, FL 33612, USA Abstract BACKGROUND: Recent studies suggest local surgical therapy improves survival in metastatic breast cancer (MBC). We evaluate the difference in outcome in patients with MBC after mastectomy versus breast conservation (BCT) and factors that influence outcome. METHODS: In a retrospective review of our prospective database, we identified patients who presented with MBC (1990 to 2007). Patient surgery type and clinicopathologic factors were reviewed. We compared OS between pts dependent on surgery and clinicopathologic factors. RESULTS: Of the 566 patients with MBC, 154 (27%) underwent removal of the primary tumor. Surgery was associated with an improved OS (33%) versus no surgery (20%) (P = 0.0015). Of those undergoing local therapy; mastectomy was associated with a 37% OS vs BCT with a 20% OS (P = 0.04). CONCLUSIONS: Our study confirms that removal of the primary tumor in MBC is associated with improved overall survival. It appears that mastectomy is associated with a significantly improved overall survival. © 2009 Elsevier Inc. All rights reserved. KEYWORDS: Surgery; Stage IV; Metastatic; Breast cancer Traditionally, removal of the primary tumor in the setting of metastatic breast cancer has not been associated with improved survival. In the past, treatment of stage IV breast cancer, even in the setting of an intact primary tumor, has been systemic therapy. Surgical intervention and/or radia- tion have been used only for palliation or prevention of local symptoms (such as skin ulceration, bleeding, and infection). This has been the continued practice for treatment of ad- vanced disease because it was thought that mortality was driven by distant disease, not the local tumor. However, recent studies have suggested that treatment of the primary tumor with surgical therapy may improve outcome in pa- tients with metastatic breast cancer. 1–4 In most of these studies, patients who had more favorable disease character- istics, such as younger age, smaller tumor size, positive estrogen/progesterone receptor status, and a smaller tumor burden, were more likely to receive surgery for their pri- mary tumor. A study by Khan et al 1 showed that resection of the primary tumor provided a statistically independent survival benefit, after adjustment for the extent and type of meta- static disease and type of systemic therapy. They found that those patients who underwent total mastectomy were more likely to have negative margins and undergo nodal dissec- tion, which was determined to be the cause of the increased survival time in this group. When correcting for margin status they discovered that, given free margins, there was no difference in survival time between the partial mastectomy and total mastectomy groups. They also found that tumor size was only weakly predictive of survival and that the * Corresponding author. Tel.: +1-813-745-8046; fax: +1-813-745- 7287. E-mail address: kandace.mcguire@moffitt.org Manuscript received March 31, 2009; revised manuscript June 14, 2009 0002-9610/$ - see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2009.06.011 The American Journal of Surgery (2009) 198, 511–515