Should breast surgery be considered for patients with de novo metastatic inflammatory breast cancer?

Lauren M Drapalik; Robert Shenk; Lisa Rock; Ashley Simpson; Amanda L Amin; Megan E Miller

doi:10.1016/j.amjsurg.2024.02.007

Should breast surgery be considered for patients with de novo metastatic inflammatory breast cancer?

Am J Surg. 2024 Mar 2:S0002-9610(24)00068-0. doi: 10.1016/j.amjsurg.2024.02.007. Online ahead of print.

Authors

Lauren M Drapalik¹, Robert Shenk¹, Lisa Rock², Ashley Simpson², Amanda L Amin¹, Megan E Miller³

Affiliations

¹ Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA.
² Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
³ Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA. Electronic address: Megan.Miller6@UHhospitals.org.

PMID: 38458830
DOI: 10.1016/j.amjsurg.2024.02.007

Abstract

Introduction: We aimed to identify factors predicting surgery for de novo stage IV inflammatory breast cancer (IBC) and determine the association of surgery with overall survival (OS).

Methods: Female patients with unilateral AJCC clinical stage IV IBC treated 2010-2018 in the NCDB were identified. Logistic regression and multivariable proportional Cox hazards regressions determined factors associated with treatment and OS.

Results: Of 1049 patients, 29.1% underwent breast surgery (BS) and 70.9% had no surgery (NS). Increasing age and more recent treatment year were significantly associated with NS. 2-Year OS was superior in BS patients (71% vs 38% NS). Single-site and bone-only metastasis had no association with treatment type or OS.

Conclusion: Contrary to guidelines, 1/3 of de novo stage IV IBC patients underwent BS, and had an independent OS benefit irrespective of extent or site of metastasis. Further research is needed to determine which patients with stage IV IBC should undergo BS.

Keywords: Breast surgery; De novo metastatic breast cancer; Inflammatory breast cancer; Modified radical mastectomy; Overall survival; Stage IV metastatic breast cancer.