1
|
Mudgway R, Chavez de Paz Villanueva C, Lin AC, Senthil M, Garberoglio CA, Lum SS. The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy. Ann Surg Oncol 2020; 27:2711-2720. [PMID: 32157524 DOI: 10.1245/s10434-020-08310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We sought to examine the impact of primary tumor resection on survival in HER2+ stage IV breast cancer patients in the era of HER2 targeted therapy. METHODS We conducted a retrospective cohort study of women with HER2+ stage IV breast cancer in the National Cancer Database from 2010 to 2012 comparing those who did and did not undergo definitive breast surgery. RESULTS Of 3231 patients, treatment included primary site surgery in 35.0%; chemo/targeted therapy in 89.4%; endocrine therapy in 37.7%; and radiation in 31.8%. Surgery was associated with Medicare/other government (OR 1.36, 95% CI 1.03-1.81) or private insurance (OR 1.93, 95% CI 1.53-2.42) versus none/Medicaid, radiation (OR 2.10, 95% CI 1.76-2.51), chemo/targeted therapy (OR 1.99, 95% CI 1.47-2.70), and endocrine therapy (OR 1.73, 95% CI 1.40-2.14). Non-Hispanic Black versus White patients (OR 0.68, 95% CI 0.53-0.87) were less likely to have surgery. Overall mortality was associated with insurance (Medicare/other government versus none/Medicaid, HR 0.36, p < 0.0001), receipt of chemo/targeted therapy (HR 0.76, p = 0.008), endocrine therapy (HR 0.70, p = 0.0006), and radiation therapy (HR 1.33, p = 0.0009), NH Black versus White race/ethnicity (HR 1.39, p = 0.002), visceral versus bone-only metastases (HR 1.44, p = 0.0003), and lowest versus highest income quartile (HR 1.36, p = 0.01). Propensity score analysis showed surgery was associated with improved survival versus no surgery (HR 0.56, 95% CI 0.40-0.77). CONCLUSIONS Surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in selected patients.
Collapse
Affiliation(s)
- Ross Mudgway
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA.,School of Medicine, University of California, Riverside, Riverside, CA, USA
| | | | - Ann C Lin
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Maheswari Senthil
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Carlos A Garberoglio
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Sharon S Lum
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Loma Linda University, Loma Linda, CA, USA. .,School of Medicine, University of California, Riverside, Riverside, CA, USA.
| |
Collapse
|
2
|
Erol T, İmamoğlu NE, Aydin B, Taşkiran ZE, Esendağli G, Kösemehmetoğlu K, Baykal A. Primary tumor resection for initially staged IV breast cancer: An emphasis on programmed death-ligand 1 expression, promoter methylation status, and survival. Medicine (Baltimore) 2019; 98:e16773. [PMID: 31415379 PMCID: PMC6831165 DOI: 10.1097/md.0000000000016773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Conventional therapy modalities for advanced breast cancer are problematic, whereas checkpoint blockade immunotherapy has been considered as a promising approach. This study aims to determine programmed death-ligand 1 (PD-L1) expression and methylation status of PD-L1 promoter in primary tumor tissue and metastatic foci of patients with stage IV breast cancer.Clinicopathological data and survival rates of 57 breast cancer patients, who were initially staged IV, and operated for intact tumors, were retrospectively analyzed. Immunohistochemical analysis of PD-L1 using 57 primary tumors, 33 paired metastatic lymph nodes, and 14 paired distant metastases was performed. Additionally, the methylation rate of the PD-L1 gene promoter region was determined with real-time polymerase chain reaction (PCR) analysis in 38 samples.Overall PD-L1 expression in primary tumors was 23.1% (12/52). PD-L1 positivity was reduced in lymph nodes by 15.2% (5/33) and in distant metastases by 21.4% (3/14). PD-L1 expression diverged between primary and metastatic foci in a subset of cases (18.2% for lymph node and 33.3% for distant metastasis). In general, the PD-L1 promoter was not methylated, and mean methylation rates were low (min. 0%-max. 21%). We observed no correlation between PD-L1 expression, promoter methylation, and survival.Neither the expression nor the methylation status of PD-L1 in patients, who were presented with stage IV breast cancer and operated for an intact primary tumor, had a statistically significant relation with survival. Discordance in PD-L1 expression between primary tumor and metastasis should be considered during pathological and clinical management of patients who would undergo checkpoint blockade therapy.
Collapse
Affiliation(s)
| | | | | | - Z. Ekim Taşkiran
- Department of Medical Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | | |
Collapse
|
3
|
Zhang D, Dong Y, Sun X, Yuan S, Yu J. Surgery of primary tumor improves the survival of newly diagnosed metastatic melanoma: a population-based, propensity-matched study. Cancer Manag Res 2018; 11:339-346. [PMID: 30643459 PMCID: PMC6312064 DOI: 10.2147/cmar.s187208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND For the melanoma patients who are with the primary tumor and metastatic disease concurrently (the newly diagnosed metastatic patients), the effect of primary tumor surgery on survival has never been discussed. OBJECTIVE We sought to estimate this effect based on data from the Surveillance, Epidemiology, and End Results database. PATIENTS AND METHODS We identified patients with newly diagnosed metastatic melanoma from 2004 to 2015. The effect of primary tumor surgery was assessed by using Cox proportional hazard regression modeling and propensity score matching. RESULTS Eight thousand three hundred and forty-one patients who had been diagnosed with primary melanoma and metastatic disease at the same time were included in this analysis, of whom 2,554 (30.6%) received primary tumor surgery. In multivariable analysis of the unmatched cohort, primary tumor surgery was an independent protective factor of overall survival (HR =0.617, 95% CI 0.565-0.674; P<0.001) and melanoma-specific survival (HR =0.599, 95% CI 0.537-0.668; P<0.001). In the matched cohort, primary tumor surgery was still associated with better overall survival (13 vs 6 months, P<0.001) and melanoma-specific survival (18 vs 6 months, P<0.001). CONCLUSION Our results reveal the benefit of primary tumor surgery on the survival of patients with newly diagnosed metastatic melanoma and may fill in the gaps of guidelines for this population. IRB IRB approval is not required because the SEER data are freely accessible.
Collapse
Affiliation(s)
- Dongxiao Zhang
- School of Medicine, Shandong University, Jinan, Shandong 250000, China
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, China, ,
| | - Yinjun Dong
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, China
| | - Xiubin Sun
- School of Public Health, Shandong University, Jinan, Shandong 250000, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, China, ,
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, China, ,
| |
Collapse
|