Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer

D. J.P. van Uden*, M. C. van Maaren, L. J.A. Strobbe, P. Bult, M. R. Stam, J. J. van der Hoeven, S. Siesling, J. H.W. de Wilt, C. F.J.M. Blanken-Peeters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: Information regarding the effects of resection of the primary tumor in stage IV inflammatory breast cancer (IBC) is scarce. We analyzed the impact of resection of the primary tumor on overall survival (OS) in a large stage IV IBC population. Materials and methods: Patients diagnosed with stage IV IBC between 2005 and 2016 were selected from the Netherlands Cancer Registry, excluding patients without any treatment. To correct for immortal time bias, we performed a landmark analysis including patients alive at least six months after diagnosis. With propensity score matching, patients undergoing surgery of the primary tumor were matched to patients not receiving surgery. Multivariable Cox proportional hazard analyses were performed to determine the association between treatment strategy and OS in the non-matched and matched cohort. Results: Of the 580 included patients after landmark analysis, 441 patients (76%) received only non-surgical treatments and 139 (24%) underwent surgery (96% mastectomy). Median follow-up was 28.8 and 20.0 months in the surgery and no surgery group, respectively. Surgery in the non-matched cohort was independently associated with better survival (HR0.56[95%CI:0.42–0.75]). In the matched cohort (n = 202), surgically treated patients had improved survival over nonsurgically treated patients (p < 0.005). Multivariable analysis of the matched cohort revealed that surgery was still associated with better survival (HR0.62[95%CI:0.44–0.87]). Conclusion: Although residual confounding and confounding by severity cannot be ruled out, this study suggests that surgery of the primary tumor is associated with improved OS and should be considered as part of the treatment strategy in stage IV IBC.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalSurgical Oncology
Volume33
DOIs
Publication statusPublished - Jun 2020

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Inflammatory Breast Neoplasms
Survival
Neoplasms
Propensity Score
Mastectomy
Therapeutics
Netherlands
Registries
Cohort Studies

Keywords

  • Inflammatory breast cancer
  • Stage IV
  • Surgery

Cite this

van Uden, D. J. P., van Maaren, M. C., Strobbe, L. J. A., Bult, P., Stam, M. R., van der Hoeven, J. J., ... Blanken-Peeters, C. F. J. M. (2020). Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer. Surgical Oncology, 33, 43-50. https://doi.org/10.1016/j.suronc.2020.01.005
van Uden, D. J.P. ; van Maaren, M. C. ; Strobbe, L. J.A. ; Bult, P. ; Stam, M. R. ; van der Hoeven, J. J. ; Siesling, S. ; de Wilt, J. H.W. ; Blanken-Peeters, C. F.J.M. / Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer. In: Surgical Oncology. 2020 ; Vol. 33. pp. 43-50.
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title = "Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer",
abstract = "Introduction: Information regarding the effects of resection of the primary tumor in stage IV inflammatory breast cancer (IBC) is scarce. We analyzed the impact of resection of the primary tumor on overall survival (OS) in a large stage IV IBC population. Materials and methods: Patients diagnosed with stage IV IBC between 2005 and 2016 were selected from the Netherlands Cancer Registry, excluding patients without any treatment. To correct for immortal time bias, we performed a landmark analysis including patients alive at least six months after diagnosis. With propensity score matching, patients undergoing surgery of the primary tumor were matched to patients not receiving surgery. Multivariable Cox proportional hazard analyses were performed to determine the association between treatment strategy and OS in the non-matched and matched cohort. Results: Of the 580 included patients after landmark analysis, 441 patients (76{\%}) received only non-surgical treatments and 139 (24{\%}) underwent surgery (96{\%} mastectomy). Median follow-up was 28.8 and 20.0 months in the surgery and no surgery group, respectively. Surgery in the non-matched cohort was independently associated with better survival (HR0.56[95{\%}CI:0.42–0.75]). In the matched cohort (n = 202), surgically treated patients had improved survival over nonsurgically treated patients (p < 0.005). Multivariable analysis of the matched cohort revealed that surgery was still associated with better survival (HR0.62[95{\%}CI:0.44–0.87]). Conclusion: Although residual confounding and confounding by severity cannot be ruled out, this study suggests that surgery of the primary tumor is associated with improved OS and should be considered as part of the treatment strategy in stage IV IBC.",
keywords = "Inflammatory breast cancer, Stage IV, Surgery",
author = "{van Uden}, {D. J.P.} and {van Maaren}, {M. C.} and Strobbe, {L. J.A.} and P. Bult and Stam, {M. R.} and {van der Hoeven}, {J. J.} and S. Siesling and {de Wilt}, {J. H.W.} and Blanken-Peeters, {C. F.J.M.}",
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van Uden, DJP, van Maaren, MC, Strobbe, LJA, Bult, P, Stam, MR, van der Hoeven, JJ, Siesling, S, de Wilt, JHW & Blanken-Peeters, CFJM 2020, 'Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer', Surgical Oncology, vol. 33, pp. 43-50. https://doi.org/10.1016/j.suronc.2020.01.005

Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer. / van Uden, D. J.P.; van Maaren, M. C.; Strobbe, L. J.A.; Bult, P.; Stam, M. R.; van der Hoeven, J. J.; Siesling, S.; de Wilt, J. H.W.; Blanken-Peeters, C. F.J.M.

In: Surgical Oncology, Vol. 33, 06.2020, p. 43-50.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer

AU - van Uden, D. J.P.

AU - van Maaren, M. C.

AU - Strobbe, L. J.A.

AU - Bult, P.

AU - Stam, M. R.

AU - van der Hoeven, J. J.

AU - Siesling, S.

AU - de Wilt, J. H.W.

AU - Blanken-Peeters, C. F.J.M.

PY - 2020/6

Y1 - 2020/6

N2 - Introduction: Information regarding the effects of resection of the primary tumor in stage IV inflammatory breast cancer (IBC) is scarce. We analyzed the impact of resection of the primary tumor on overall survival (OS) in a large stage IV IBC population. Materials and methods: Patients diagnosed with stage IV IBC between 2005 and 2016 were selected from the Netherlands Cancer Registry, excluding patients without any treatment. To correct for immortal time bias, we performed a landmark analysis including patients alive at least six months after diagnosis. With propensity score matching, patients undergoing surgery of the primary tumor were matched to patients not receiving surgery. Multivariable Cox proportional hazard analyses were performed to determine the association between treatment strategy and OS in the non-matched and matched cohort. Results: Of the 580 included patients after landmark analysis, 441 patients (76%) received only non-surgical treatments and 139 (24%) underwent surgery (96% mastectomy). Median follow-up was 28.8 and 20.0 months in the surgery and no surgery group, respectively. Surgery in the non-matched cohort was independently associated with better survival (HR0.56[95%CI:0.42–0.75]). In the matched cohort (n = 202), surgically treated patients had improved survival over nonsurgically treated patients (p < 0.005). Multivariable analysis of the matched cohort revealed that surgery was still associated with better survival (HR0.62[95%CI:0.44–0.87]). Conclusion: Although residual confounding and confounding by severity cannot be ruled out, this study suggests that surgery of the primary tumor is associated with improved OS and should be considered as part of the treatment strategy in stage IV IBC.

AB - Introduction: Information regarding the effects of resection of the primary tumor in stage IV inflammatory breast cancer (IBC) is scarce. We analyzed the impact of resection of the primary tumor on overall survival (OS) in a large stage IV IBC population. Materials and methods: Patients diagnosed with stage IV IBC between 2005 and 2016 were selected from the Netherlands Cancer Registry, excluding patients without any treatment. To correct for immortal time bias, we performed a landmark analysis including patients alive at least six months after diagnosis. With propensity score matching, patients undergoing surgery of the primary tumor were matched to patients not receiving surgery. Multivariable Cox proportional hazard analyses were performed to determine the association between treatment strategy and OS in the non-matched and matched cohort. Results: Of the 580 included patients after landmark analysis, 441 patients (76%) received only non-surgical treatments and 139 (24%) underwent surgery (96% mastectomy). Median follow-up was 28.8 and 20.0 months in the surgery and no surgery group, respectively. Surgery in the non-matched cohort was independently associated with better survival (HR0.56[95%CI:0.42–0.75]). In the matched cohort (n = 202), surgically treated patients had improved survival over nonsurgically treated patients (p < 0.005). Multivariable analysis of the matched cohort revealed that surgery was still associated with better survival (HR0.62[95%CI:0.44–0.87]). Conclusion: Although residual confounding and confounding by severity cannot be ruled out, this study suggests that surgery of the primary tumor is associated with improved OS and should be considered as part of the treatment strategy in stage IV IBC.

KW - Inflammatory breast cancer

KW - Stage IV

KW - Surgery

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U2 - 10.1016/j.suronc.2020.01.005

DO - 10.1016/j.suronc.2020.01.005

M3 - Article

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VL - 33

SP - 43

EP - 50

JO - Surgical Oncology

JF - Surgical Oncology

SN - 0960-7404

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