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Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis

BACKGROUND: Breast surgery for stage IV breast cancer remains controversial. The aim of this study was to investigate the impact of breast surgery on survival of stage IV breast cancer patients based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. METHODS: In to...

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Autores principales: Lin, Yuxiang, Huang, Kaiyan, Zeng, Qiang, Zhang, Jie, Song, Chuangui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PeerJ Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085290/
https://www.ncbi.nlm.nih.gov/pubmed/32219021
http://dx.doi.org/10.7717/peerj.8694
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author Lin, Yuxiang
Huang, Kaiyan
Zeng, Qiang
Zhang, Jie
Song, Chuangui
author_facet Lin, Yuxiang
Huang, Kaiyan
Zeng, Qiang
Zhang, Jie
Song, Chuangui
author_sort Lin, Yuxiang
collection PubMed
description BACKGROUND: Breast surgery for stage IV breast cancer remains controversial. The aim of this study was to investigate the impact of breast surgery on survival of stage IV breast cancer patients based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. METHODS: In total, 13,034 patients were selected and divided into surgery and non-surgery groups. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was utilized to achieve balanced covariates across different groups. One-to-one (1:1) PSM was conducted to construct a matched sample consisting of pairs of surgery and non-surgery subjects. Breast cancer-specific survival (BCSS) and overall survival (OS) of the two groups were assessed by Kaplan–Meier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed. RESULTS: Patients treated with breast surgery were more likely to be younger, smaller tumor size, more advanced nodal status, higher histology grade and higher proportion of bone-only metastasis. Those who received chemotherapy and radiotherapy also tended to be treated with surgery. After adjustment for potential confounders, breast surgery group exhibited a better survival both in BCSS (HR = 0.557, 95% CI [0.523–0.594], p < 0.001) and OS (HR = 0.571, 95% CI [0.537–0.607], p < 0.001). After propensity score matching, the surgery and non-surgery group consisted of 2,269 patients respectively. The median survival time was 43 months for the surgery group and 27 months for the non-surgery group. Kaplan–Meier curves indicated that breast surgery could clearly improve both the BCSS and OS for patients with stage IV breast cancer. On multivariate analysis, surgery group was associated with a better survival compared with the non-surgery group (BCSS: HR = 0.542, 95% CI [0.499–0.589], p < 0.001; OS: HR = 0.555, 95% CI [0.512–0.601], p < 0.001). Furthermore, this survival advantage persisted in all subgroups irrespective of age, race, tumor size, nodal status, histology grade, molecular subtype, chemotherapy status, radiotherapy status or status of distant metastasis. CONCLUSION: Our study provided additional evidence that patients with stage IV breast cancer could benefit from breast surgery and it might play a more important role in multimodality therapy.
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spelling pubmed-70852902020-03-26 Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis Lin, Yuxiang Huang, Kaiyan Zeng, Qiang Zhang, Jie Song, Chuangui PeerJ Oncology BACKGROUND: Breast surgery for stage IV breast cancer remains controversial. The aim of this study was to investigate the impact of breast surgery on survival of stage IV breast cancer patients based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. METHODS: In total, 13,034 patients were selected and divided into surgery and non-surgery groups. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was utilized to achieve balanced covariates across different groups. One-to-one (1:1) PSM was conducted to construct a matched sample consisting of pairs of surgery and non-surgery subjects. Breast cancer-specific survival (BCSS) and overall survival (OS) of the two groups were assessed by Kaplan–Meier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed. RESULTS: Patients treated with breast surgery were more likely to be younger, smaller tumor size, more advanced nodal status, higher histology grade and higher proportion of bone-only metastasis. Those who received chemotherapy and radiotherapy also tended to be treated with surgery. After adjustment for potential confounders, breast surgery group exhibited a better survival both in BCSS (HR = 0.557, 95% CI [0.523–0.594], p < 0.001) and OS (HR = 0.571, 95% CI [0.537–0.607], p < 0.001). After propensity score matching, the surgery and non-surgery group consisted of 2,269 patients respectively. The median survival time was 43 months for the surgery group and 27 months for the non-surgery group. Kaplan–Meier curves indicated that breast surgery could clearly improve both the BCSS and OS for patients with stage IV breast cancer. On multivariate analysis, surgery group was associated with a better survival compared with the non-surgery group (BCSS: HR = 0.542, 95% CI [0.499–0.589], p < 0.001; OS: HR = 0.555, 95% CI [0.512–0.601], p < 0.001). Furthermore, this survival advantage persisted in all subgroups irrespective of age, race, tumor size, nodal status, histology grade, molecular subtype, chemotherapy status, radiotherapy status or status of distant metastasis. CONCLUSION: Our study provided additional evidence that patients with stage IV breast cancer could benefit from breast surgery and it might play a more important role in multimodality therapy. PeerJ Inc. 2020-03-18 /pmc/articles/PMC7085290/ /pubmed/32219021 http://dx.doi.org/10.7717/peerj.8694 Text en ©2020 Lin et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.
spellingShingle Oncology
Lin, Yuxiang
Huang, Kaiyan
Zeng, Qiang
Zhang, Jie
Song, Chuangui
Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title_full Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title_fullStr Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title_full_unstemmed Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title_short Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis
title_sort impact of breast surgery on survival of patients with stage iv breast cancer: a seer population-based propensity score matching analysis
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085290/
https://www.ncbi.nlm.nih.gov/pubmed/32219021
http://dx.doi.org/10.7717/peerj.8694
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