Background: Primary tumor resection in metastatic breast cancer (MBC) remains a
palliative procedure. Its impact as an upfront option on survival is debatable. No data
from our locality addressed this issue; we conducted this retrospective study to ex-
plore its benefit as regards time-to-progression and/or time-to-death.
Methods: Data of patients’ medical records used between 2010 through 2015 from
Sohag Cancer Institute (SCI) and Sohag University Hospital, Egypt. Patients diag-
nosed with de novo MBC who had surgery before starting systemic treatment (ST) or
had ST only were eligible. Cox proportional hazard regression and Kaplan-Meier
estimates and descriptive statistics were used.
Results: Overall, 332 patients with MBC were included. They were pathologically
proven MBC at presentation, HER2 negative, any HR status. Among them, 144 cases
had upfront local surgery and matched to 188 who had not. Median PFS for ST group
was 1.75 years while for surgery group was 2.41 years (p value=0.36). Median OS
was 4.77 years and >5 years for ST and surgery groups respectively (p value=0.11).
In multivariate analysis, progression of the disease was significantly associated with
lower OS (HR, 4.63; 95% CI, p value= 0.03).
Conclusion: Primary tumor resection followed by systemic treatment was similar to
systemic treatment alone as regards overall mortality and risk of progression in
MBC. So, primary breast tumor resection in MBC should not be routinely used as
frontline therapy but it may be considered in selected cases.