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. 2025 May 13:15:1590246.
doi: 10.3389/fonc.2025.1590246. eCollection 2025.

Effect of locoregional surgery in primary tumors on overall survival in patients with de novo stage IV breast cancer: a systematic review and meta-analysis

Yanbo Sun #  1   2 , Hao Ma #  1   2 , Yingjie Li  1   2 , Can Zhou  1
Affiliations

Effect of locoregional surgery in primary tumors on overall survival in patients with de novo stage IV breast cancer: a systematic review and meta-analysis

Yanbo Sun et al. Front Oncol. .

Abstract

Background: Due to the controversy in the therapeutic effect of locoregional surgery in primary tumors for patients with de novo stage IV breast cancer, the aim of this study was to evaluate the effect of locoregional surgery on overall survival in patients with de novo stage IV breast cancer.

Methods: A computer-based search of PUBMED, Embase, and American Society of Oncology (ASCO) annual meetings abstracts was conducted to identify the prospective trials of the combination of locoregional surgery in primary tumors and systemic therapy in comparison with standard systemic therapy alone for patients with de novo stage IV breast cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated by universal inverse variance and combined across articles. Random-effects model and subgroup analyses were performed to ascertain the origin of this heterogeneity.

Results: A total of 2029 patients from 8 studies were included, with 1014 patients (49.98%) underwent locoregional surgery in primary tumors (surgery group) and 1015 ones (50.02%) with standard systemic therapy alone (no surgery group). Compared to patients in the no surgery group, participants with ER/PR positive breast cancer in the surgery group had improved overall survival (OS) (HR=0.77, 95%CI 0.55-0.93, P=0.01), and improved locoregional progression-free survival (HR=0.36, 95%CI 0.14-0.95, P=0.04) for all participants in the surgery group. And patients with bone-only metastases in the surgery group had insignificantly favorable OS than those in no surgery group (HR=0.70, 95%CI, 0.47-1.04, P=0.08).

Conclusion: Our study demonstrated that locoregional surgery in primary tumors was associated with improved OS for participants with ER/PR positive de novo stage IV breast cancer, and locoregional surgery in primary tumors could be worthy of clinical recommendation for patients with ER/PR positive de novo stage IV breast cancer.

Keywords: ER/PR-positive; de novo stage IV breast cancer; locoregional surgery; meta-analysis; overall survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature screening according to PRISMA guidelines.
Figure 2
Figure 2
Forest plot: overall survival.
Figure 3
Figure 3
Forest plot: 2-years overall survival.
Figure 4
Figure 4
Forest plot: 3-years overall survival.
Figure 5
Figure 5
Results of the meta-analysis of local progression-free survival among patients with de novo stage IV breast cancer.
Figure 6
Figure 6
Meta-analysis of distant progression-free survival among patients with de novo stage IV breast cancer.
Figure 7
Figure 7
Results of subgroup analysis of overall survival by molecular subtype for surgical versus nonsurgical comparison.
Figure 8
Figure 8
Results of subgroup analysis comparing overall survival of metastatic sites with surgery and without surgery.
Figure 9
Figure 9
Risk plots for each study assessed using the Cochrane risk of bias tool.
Figure 10
Figure 10
Funnel plot for statistical analysis of the studies included in the meta-analysis.
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