Ruizhe Yue, Zheng Wang, Hao Zhang
Primary tumor surgery was associated with longer OS and BCSS in patients with de novo stage IV TNBC with visceral metastases. This observed association may partly reflect patient selection, underlying health status, metastatic burden, and response to systemic therapy. Therefore, these findings should be interpreted as hypothesis-generating real-world evidence rather than definitive evidence of a causal treatment benefit. Individualized surgical decision-making should be based on careful patient selection and multidisciplinary evaluation.
BACKGROUND: The role of primary tumor surgery in patients with de novo stage IV triple-negative breast cancer (TNBC) with visceral metastases remains controversial. This study investigated the association between primary tumor surgery and survival outcomes in this high-risk population.
METHODS: Female patients diagnosed with de novo stage IV TNBC with liver, lung, and/or brain metastases between 2010 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and breast cancer-specific survival (BCSS) were compared between patients who underwent primary tumor surgery and those who did not. Propensity score matching (PSM), Kaplan-Meier analysis, Cox regression, subgroup analysis, robust sensitivity analysis, and restricted mean survival time (RMST) analysis were performed.
RESULTS: A total of 1,827 patients were included, of whom 543 underwent primary tumor surgery and 1,284 did not. After 1:1 PSM, 507 matched pairs were generated. After matching, the median OS was 15 months in the surgery group and 9 months in the non-surgery group, while the median BCSS was 15 months and 10 months, respectively. In multivariable Cox analysis, primary tumor surgery was independently associated with longer OS [hazard ratio (HR) =0.532, 95% confidence interval (CI): 0.462-0.612, P<0.001] and BCSS (HR =0.544, 95% CI: 0.470-0.629, P<0.001). These associations remained stable in robust Cox sensitivity analyses. RMST analyses at 24 and 36 months further supported the robustness of the observed survival association.
CONCLUSIONS: Primary tumor surgery was associated with longer OS and BCSS in patients with de novo stage IV TNBC with visceral metastases. This observed association may partly reflect patient selection, underlying health status, metastatic burden, and response to systemic therapy. Therefore, these findings should be interpreted as hypothesis-generating real-world evidence rather than definitive evidence of a causal treatment benefit. Individualized surgical decision-making should be based on careful patient selection and multidisciplinary evaluation.