Effect of Primary Surgery on Health-Related Quality of Life in Metastatic Breast Cancer: A Systematic Review of RCT's

Background: Primary surgery in metastatic breast cancer (MBC) has been a subject of debate in part due to the heterogeneity of the results of individual studies. We synthesized evidence from the existing randomized clinical trials (RCTs) to evaluate the effect of primary surgery on health-related quality of life (HRQoL) in MBC. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and ClinicalTrials.gov and gray literature till January 2025. Included were RCTs among patients with MBC for whom outcome data on HRQOL was reported. Results: Of the 1019 records screened, four RCTs (961 patients) were included. The risk of bias was high in one RCT and moderate in three. Four HRQoL tools were deployed. Three moderate-quality RCTs measured HRQoL specifically at 18 months: One was in favor of surgery (BR23 18.7 vs. 10.0, P = 0.009), one showed no difference (BR23 10.4 vs. 12.0, P = 0.45), and one was in favor of avoiding surgery (FACT-B 74.2 vs. 68.0, P = 0.005). Two moderate-quality RCTs measured HRQoL generically at 18 months: None showed any difference (C30 64.7 vs. 60.0, P = 0.3 and C30 63.5 vs 68.7, P = 0.2). One low-quality RCT measured HRQoL generically at 36 months: It showed no difference (SF-12 40.8 vs. 43.4, P = 0.34). Primary surgery improved specific HRQoL at 18 months in one study and deteriorated in another, compared to non-surgical treatment, among moderate-quality trials. Conclusion: The pros and cons of surgery as a palliative option should be considered in shared decision-making for improving life quality among individual patients.