Primary treatments for stage IV breast cancer are chemotherapy and endocrine therapy. We sought to determine whether multidisciplinary therapy provides a survival advantage for women with metastatic breast cancer.
We conducted a population-based cohort study by using the 2010-2014 Surveillance, Epidemiology, and End Results (SEER) program data. By use of the log-rank test and multivariate cox regression models, overall survival in patients was compared between women who underwent different combination modes of surgery, radiotherapy and chemotherapy, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores.
Of 17191 SEER patients with de novo stage IV breast cancer, 29.4% underwent surgery, 32.3% received radiotherapy and 49.6% received chemotherapy. The median follow-up was 28.0 months for all patients. The median survival time of combined surgery, chemotherapy and radiotherapy(SCRT), combined surgery and radiotherapy(SRT),combined surgery and chemotherapy(SC), combined chemotherapy and radiotherapy (CRT), surgery alone, chemotherapy alone, radiotherapy alone and no therapy were 51.0m (95%CI, NR), 46m (95%CI, 39.7-52.3), 37.0m (95%CI, 33.4-40.6), 22.0m (95%CI, 20.0-24.0), 29.0m (95%CI, 25.3-32.7), 26.0m (95%CI, 24.5-27.5), 22.0m (95%CI, 19.9-24.1) and 13.0m (95%CI, 11.8-14.2), respectively (p<0.001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery, radiotherapy and chemotherapy were less likely to die compared with patients who did not undergo surgery, radiotherapy and chemotherapy,respectively (HR = 0.32, 95% CI, 0.30-0.34, p<0.001, HR = 0.40, 95%CI, 0.38-0.43, p<0.001 and HR = 0.51, 95%CI, 0.48-0.54, p<0.001). There was no statistically significant difference among patients with different breast cancer subtype.
Analysis of 2010-2014 SEER data indicated that multidisciplinary approach is especially important in the management of newly diagnosed metastatic breast cancer to consider all potential treatment options for optimal outcomes.
Jian Zhang.
Has not received any funding.
All authors have declared no conflicts of interest.