The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study

doi:10.1245/s10434-021-09621-8

. 2021 Sep;28(9):5048-5057.

doi: 10.1245/s10434-021-09621-8. Epub 2021 Feb 2.

The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study

Atilla Soran¹, Lutfi Dogan², Arda Isik³, Serdar Ozbas⁴, Didem Can Trabulus⁵, Umut Demirci⁶, Hasan Karanlik⁷, Aykut Soyder⁸, Ahmet Dag⁹, Ahmet Bilici¹⁰, Mutlu Dogan¹¹, Hande Koksal¹², Mehmet Ali Nahit Sendur¹³, Mehmet Ali Gulcelik¹⁴, Gokturk Maralcan¹⁵, Neslihan Cabioglu¹⁶, Levent Yeniay¹⁷, Zafer Utkan¹⁸, Turgay Simsek¹⁸, Nuri Karadurmus¹⁹, Gul Daglar⁴, Birol Yildiz¹⁹, Cihan Uras²⁰, Mustafa Tukenmez¹⁶, Ahmet Yildirim¹¹, Suat Kutun², Cihangir Ozaslan², Niyazi Karaman²¹, Müfide Nuran Akcay²², Osman Toktas²³, Efe Sezgin²⁴

Affiliations

¹ Division of Surgical Oncology, UPMC (University of Pittsburgh Medical Center) Magee-Womens Hospital, Pittsburgh, USA. asoran@upmc.edu.
² Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
³ Department of Surgery, Erzincan Binali Yıldırım University, Erzincan, Turkey.
⁴ Private, Breast and Endocrine Surgeon, Ankara, Turkey.
⁵ Department of Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
⁶ Department of Medical Oncology, Memorial Ankara Hospital, University of Uskudar School of Medicine, Istanbul, Turkey.
⁷ Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.
⁸ Department of Surgery, School of Medicine, Adnan Menderes University, Aydın, Turkey.
⁹ Department of Surgery, School of Medicine, Mersin University, Mersin, Turkey.
¹⁰ Department of Medical Oncology, School of Medicine, Medipol University, Istanbul, Turkey.
¹¹ Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
¹² Department of Surgery, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey.
¹³ Department of Medical Oncology, School of Medicine, Yıldırım Beyazit University, Ankara, Turkey.
¹⁴ Department of Surgical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
¹⁵ Department of Surgery, School of Medicine, Sanko University, Gaziantep, Turkey.
¹⁶ Department of Surgery, School of Medicine Istanbul University, Istanbul, Turkey.
¹⁷ Department of Surgery, School of Medicine, Ege University, Izmir, Turkey.
¹⁸ Department of Surgery, School of Medicine, Kocaeli University, İzmit, Turkey.
¹⁹ Department of Medical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
²⁰ Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey.
²¹ Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
²² Department of Surgery, School of Medicine, Atatürk University, Erzurum, Turkey.
²³ Department of Surgery, School of Medicine, Yuzuncuyıl University, Van, Turkey.
²⁴ Department of Food and Engineering, Faculty of Engineering, Izmir Institute of Technology, Izmir, Turkey.

PMID: 33532878
DOI: 10.1245/s10434-021-09621-8

The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study

Atilla Soran et al. Ann Surg Oncol. 2021 Sep.

. 2021 Sep;28(9):5048-5057.

doi: 10.1245/s10434-021-09621-8. Epub 2021 Feb 2.

Authors

Affiliations

¹ Division of Surgical Oncology, UPMC (University of Pittsburgh Medical Center) Magee-Womens Hospital, Pittsburgh, USA. asoran@upmc.edu.
² Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
³ Department of Surgery, Erzincan Binali Yıldırım University, Erzincan, Turkey.
⁴ Private, Breast and Endocrine Surgeon, Ankara, Turkey.
⁵ Department of Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
⁶ Department of Medical Oncology, Memorial Ankara Hospital, University of Uskudar School of Medicine, Istanbul, Turkey.
⁷ Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.
⁸ Department of Surgery, School of Medicine, Adnan Menderes University, Aydın, Turkey.
⁹ Department of Surgery, School of Medicine, Mersin University, Mersin, Turkey.
¹⁰ Department of Medical Oncology, School of Medicine, Medipol University, Istanbul, Turkey.
¹¹ Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
¹² Department of Surgery, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey.
¹³ Department of Medical Oncology, School of Medicine, Yıldırım Beyazit University, Ankara, Turkey.
¹⁴ Department of Surgical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
¹⁵ Department of Surgery, School of Medicine, Sanko University, Gaziantep, Turkey.
¹⁶ Department of Surgery, School of Medicine Istanbul University, Istanbul, Turkey.
¹⁷ Department of Surgery, School of Medicine, Ege University, Izmir, Turkey.
¹⁸ Department of Surgery, School of Medicine, Kocaeli University, İzmit, Turkey.
¹⁹ Department of Medical Oncology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
²⁰ Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey.
²¹ Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
²² Department of Surgery, School of Medicine, Atatürk University, Erzurum, Turkey.
²³ Department of Surgery, School of Medicine, Yuzuncuyıl University, Van, Turkey.
²⁴ Department of Food and Engineering, Faculty of Engineering, Izmir Institute of Technology, Izmir, Turkey.

PMID: 33532878
DOI: 10.1245/s10434-021-09621-8

Abstract

Background: More evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM).

Methods: The prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group).

Results: We included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30-0.54, p < 0.0001).

Conclusion: In this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.

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Comment in

Re: The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multicenter, Prospective Registry Study.
Ishizuka Y, Horimoto Y. Ishizuka Y, et al. Ann Surg Oncol. 2021 Dec;28(Suppl 3):784. doi: 10.1245/s10434-021-10528-7. Epub 2021 Sep 12. Ann Surg Oncol. 2021. PMID: 34514520 No abstract available.

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References

1. Hellman S. Natural history of small breast cancers. J Clin Oncol. 1994;12:2229–34. - DOI
1. Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol. 2004;22:3302–8. - DOI
1. Gnerlich J, Jeffe DB, Deshpande AD, et al. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol. 2007;14:2187–94. - DOI
1. Babiera GV, Rao R, Feng L, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol. 2006;13:776–82. - DOI
1. Pérez-Fidalgo JA, Pimentel P, Caballero A, et al. Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast. 2011;20:548–54. - DOI

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[1] Hellman S. Natural history of small breast cancers. J Clin Oncol. 1994;12:2229–34. - DOI

[2] Hellman S. Natural history of small breast cancers. J Clin Oncol. 1994;12:2229–34. - DOI

[3] Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol. 2004;22:3302–8. - DOI

[4] Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol. 2004;22:3302–8. - DOI

[5] Gnerlich J, Jeffe DB, Deshpande AD, et al. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol. 2007;14:2187–94. - DOI

[6] Gnerlich J, Jeffe DB, Deshpande AD, et al. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol. 2007;14:2187–94. - DOI

[7] Babiera GV, Rao R, Feng L, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol. 2006;13:776–82. - DOI

[8] Babiera GV, Rao R, Feng L, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol. 2006;13:776–82. - DOI

[9] Pérez-Fidalgo JA, Pimentel P, Caballero A, et al. Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast. 2011;20:548–54. - DOI

[10] Pérez-Fidalgo JA, Pimentel P, Caballero A, et al. Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast. 2011;20:548–54. - DOI

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The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study

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The Effect of Primary Surgery in Patients with De Novo Stage IV Breast Cancer with Bone Metastasis Only (Protocol BOMET MF 14-01): A Multi-Center, Prospective Registry Study

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