| Objective: To retrospectively analyze the clinical data of primary stage Ⅳbreast cancer patients and the effect of surgical removal of the primary tumor on the survival of patients,so as to provide some guidance for future clinical work.Methods: From January 2011 to December 2017,clinical data of patients diagnosed as stage IV breast cancer in Guangxi Cancer Hospital were collected.A total of 152 patients were included in the study.According to the surgical resection of the primary tumor,it was divided into surgical and non-surgical groups,and the total survival time and related influencing factors of the two groups of patients were analyzed,as well as the related problems of surgery.Impact.Results: 1.This study included 152 patients with newly treated stage Ⅳbreast cancer,divided into two groups,of which 96 patients received surgical treatment and 56 patients did not receive surgical treatment.The average time from initial diagnosis to operation in the surgical group was 3.84 months,and the median follow-up time was 33.0 months(6 to 88 months).Compared with the non-surgical group,the primary tumor T0-2 in the surgical group was more common(29.2% vs 8.9%,p=0.013).There was no significant difference in axillary lymph node metastasis between the two groups.ER positive was more common in the surgical group than in the non-surgical group(66.7% vs 51.8%,p=0.042).The most common distant metastasis site is bone.The single bone metastasis rate in the surgical group was higher than that in the non-surgical group(42.7%vs 7.1%,p<0.001);the multiple metastasis rate in the non-operative group was higher than that in the surgical group(48.2% vs 18.8 %,p<0.001).Endocrine therapy was more common in the surgical group than in the non-surgical group(60.4% vs 39.3%,p=0.036).The proportion of primary focus radiotherapy in the surgical group was higher than that in the non-operative group(28.1% vs 3.6,p=0.002).Other clinical and pathological features,including BMI,menstrual status,axillary lymph node staging,PR,HER2 expression,chemotherapy and targeted therapy,were not significantly different between the two groups(p>0.05).2.The median survival time in the non-surgical group was 28 months(95% CI 20.236～35.764),and the median survival time in the surgical group was 45 months(95% CI 38.499～51.501).The median survival time in the surgical group was significantly higher than that in the non-surgical group(p=0.001).The median survival time of PFS in the non-surgical group was 6months(95%CI 4.575～7.425),and the median survival time of PFS in the surgical group was 10 months(95%CI 7.511～12.489).The median survival time of PFS in the operative group was significantly higher than that in the non-operative group(p=0.001).3.Univariate analysis showed that age of onset,T stage of primary tumor,distant metastatic site and operation were related to the patient’s PFS(p<0.05);T stage of primary tumor,distant metastatic site,chemotherapy,endocrine therapy and surgery The situation is related to the patient’s OS(p<0.05).Multivariate analysis indicated that chemotherapy and endocrine therapy were related to OS(HR=0.367,p=0.049;HR=0.459,p=0.004).Stratified analysis showed that patients with primary tumor T3-4,Luminal A,TNBC,bone metastasis,and single visceral metastasis had higher OS than non-surgical group(p<0.05).4.The proportion of patients with primary tumors with early T staging is higher(p=0.013).Of the 96 patients undergoing surgery,80(83.3%)were treated after systemic treatment,and 16(16.7%)were treated before systemic treatment.According to the preoperative treatment,they were divided into SD+PD group,PR+PCR group and first hand in the postoperative systemic treatment group,there was no significant difference in postoperative PFS and OS between the three groups(p=0.242 vs.p=0.348).There was no significant difference in postoperative PFS and OS between patients undergoing axillary lymph node dissection and regional lymph node dissection(p>0.05).Conclusion: 1.Resection of primary lesions can help improve the prognosis of patients with stage IV breast cancer who are newly diagnosed.2.Multivariate analysis indicates that chemotherapy and endocrine therapy are independent prognostic factors affecting OS.3.Preoperative treatment and axillary lymph node dissection do not affect the overall survival of patients treated with primary tumor resection. |
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