Ten-Year Analysis of Mastectomy in Stage IV Breast Cancer: Practice Patterns and Outcomes

BackgroundCurrently no level 1 data clearly demonstrates a survival benefit from operative therapy in patients with de novo metastatic breast cancer (dnMBC); thus, NCCN guidelines reserve mastectomy for palliation only. However, as multimodal therapies improve, disease management over a longer period may benefit certain patients who are on the continuum between curative and palliative intent.MethodsA retrospective review was performed of all female patients with dnMBC treated between 2014-2024 at our institution. The cohort was divided into 2 groups: those patients who underwent mastectomy and those who did not. Clinicopathologic factors and patient outcomes of both groups were analyzed.ResultsOf the 92 patients meeting inclusion criteria, total mastectomy was performed in 37 (40%) patients. Surgical resection was more commonly associated with oligometastatic bone disease (11.5% vs 0%, P < .01) and not with widespread metastasis involving multiple systems (24.3% vs 50.9%, P = 0.02). Surgical patients had significantly higher rates of complete response and stable disease after upfront systemic therapy (32.4% vs 12.7% and 18.9% vs 3.6%, respectively) while nonsurgical patients had a significantly higher rate of disease progression (32.7% vs 2.7%). The median OS was higher in surgical patients (NR vs 3.95 years, P < .01).DiscussionPrimary site surgery played an important role as part of a multimodal disease management paradigm in dnMBC patients at our institution. Future studies should evaluate which patients on the continuum between curative and palliative intent may benefit the most from this strategy, which may help standardize surgical care in these clinically challenging patients.