ドイハラ　ヒロヨシ   Hiroyoshi Doihara   土井原　博義    所属   川崎医科大学  医学部 臨床医学　総合外科学    職種   特任教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Effect of local surgery on outcomes of stage IV breast cancer.
掲載誌名	正式名：Translational cancer research 略　 称：Transl Cancer Res ISSNコード：22196803/2218676X
掲載区分	国外
巻・号・頁	9(8),pp.5102-5107
著者・共著者	Tsukioki Takahiro, Shien Tadahiko, Doihara Hiroyoshi
発行年月	2020/08
概要	Metastatic breast cancer (MBC), including de novo stage IV, is regarded as being incurable and the mainstay of clinical management is systemic therapy. Traditionally, locoregional surgery is performed only for local control, such as to prevent ulceration and bleeding. In recent years, however, both retrospective and prospective studies have demonstrated the prognostic efficacy of primary surgery for de novo stage IV patients. Therefore, we conducted a meta-analysis to evaluate whether surgical therapy contributes to overall survival (OS) extension. We searched for clinical trials published in electronic databases (PubMed, Embase, and the Cochrane databases) and performed a meta-analysis of the data collected. There were five prospective randomized controlled phase III trials (RCTs). The results of three have been reported. According to our meta-analysis of these RCTs, primary surgery for de novo stage IV breast cancer patients significantly improves OS. However, the Tata trial showed that systemic therapy does not achieve a sufficient effect. Another trial, conducted in Turkey, had statistical shortcomings and patient randomization was not adequately performed The ABCSG (Austrian Breast and Colorectal Cancer Study Group) trial had too few subjects. Meta-analysis of 12 retrospective studies showed that patients with stage IV breast cancer receiving surgery as the initial treatment experienced longer OS (HR: 0.65, P<0.00001). Based on our meta-analysis of three reported RCTs, surgery as the primary treatment does not significantly impact the outcomes of de novo stage IV breast cancer patients. However, these trials had limitations. We await the results of the remaining two ongoing RCTs (ECOG 2108 and JCOG 1017). These trials are anticipated to resolve current controversies and provide many eagerly awaited answers.
DOI	10.21037/tcr.2020.01.60
PMID	35117876