Operatie: Een operatieve verwijdering van de primaire tumor bij reeds uitgezaaide borstkanker geeft toch significant betere overlevingskansen, vooral bij vrouwen met alleen uitzaaiingen in de botten.

27 mei 2006: Bron: J Clin Oncol. 2006 May 15;

Hoewel in de praktijk hier anders mee om wordt gegaan, wie al uitzaaiingen heeft krijgt in principe geen operatie meer aangeboden, blijkt een operatieve verwijdering van de primaire tumor bij uitgezaaide borstkanker, vooral bij vrouwen met alleen botuitzaaiingen, zeker zinvol blijkt uit een overzichtstudie uitgevoerd bij ruim 5000 vrouwen waaronder 300 vrouwen die toch geopereerd werden ondanks hun uitzaaiïngen over een periode van 20 jaar

RESULTATEN: Vrouwen die een complete verwijdering hadden gehad van de primaire borsttumor met negatieve operatieve marges hadden een 40% verminderd risico op overlijden direct gerelateerd aan hun borstkanker. (multiadjusted hazard ratio , 0.6; 95% CI, 0.4 to 1.0) vergeleken met vrouwen die geen operatie hadden gehad. (P = .049). Deze overlijdens risico vermindering was niet statistisch significant voor vrouwen met uitzaaiïngen op verschillende andere plaatsen maar wel specifiek significant voor vrouwen met alleen botuitzaaiïngen tijdens de diagnose. (HR, 0.2; 95% CI, 0.1 to 0.4; P = .001). De overleving van vrouwen die geopereerd waren met positieve operatieve marges was niet verschillend van de vrouwen die geen operatie hadden gehad.

CONCLUSIE: Complete verwijdering van de primaire tumor verbetert de kansen op overleving van patiënten met uitgezaaide borstkanker, specifiek voor die vrouwen die alleen botuitzaaiingen hadden.

J Clin Oncol. 2006 May 15;

Complete Excision of Primary Breast Tumor Improves Survival of Patients With Metastatic Breast Cancer at Diagnosis.

Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP, Chappuis PO, Bouchardy C.

Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva; Department of Obstetrics and Gynecology, Unit of Senology and Gynecologic Oncology, Service of Oncology, and Service of Medical Genetics, Geneva University Hospitals, Geneva, Switzerland.

PURPOSE: Surgery of the primary tumor usually is not advised for patients with metastatic breast cancer at diagnosis because the disease is considered incurable. In this population-based study, we evaluate the impact of local surgery on survival of patients with metastatic breast cancer at diagnosis.

METHODS: We included all 300 metastatic breast cancer patients recorded at the Geneva Cancer Registry between 1977 and 1996. We compared mortality risks from breast cancer between patients who had surgery of the primary breast tumor to those who had not and adjusted these risks for other prognostic factors.

RESULTS: Women who had complete excision of the primary breast tumor with negative surgical margins had a 40% reduced risk of death as a result of breast cancer (multiadjusted hazard ratio , 0.6; 95% CI, 0.4 to 1.0) compared with women who did not have surgery (P = .049). This mortality reduction was not significantly different among patients with different sites of metastasis, but in the stratified analysis the effect was particularly evident for women with bone metastasis only (HR, 0.2; 95% CI, 0.1 to 0.4; P = .001). Survival of women who had surgery with positive surgical margins was not different from that of women who did not have surgery.

CONCLUSION: Complete surgical excision of the primary tumor improves survival of patients with metastatic breast cancer at diagnosis, particularly among women with only bone metastases.

PMID: 16702580 [PubMed - as supplied by publisher]

Bron: Medscape:

Zo schrijft Medscape over deze studie.

Women With Metastatic Breast Cancer Can Benefit From Surgery

WASHINGTON (Reuters) May 16 - Surgery greatly increases a patient's chances of surviving with breast cancer, even if the cancer has spread by the time a woman is diagnosed, Swiss researchers reported on Monday. Although many women whose disease has progressed are only offered palliative care, surgery could help them live much longer, the researchers found. "Based on these findings, we believe that it is time to take a hard look at the current standard of care for breast cancer patients initially diagnosed with metastatic disease," said Dr. Elisabetta Rapiti of the Geneva Cancer Registry at the University of Geneva, who led the study. "Our study strongly suggests that surgery of the primary tumor could provide an important survival gain for women with metastatic breast cancer at initial diagnosis," Dr. Rapiti added in a statement. Dr. Rapiti's team evaluated the patient records of 5,000 women who were diagnosed with breast cancer over the past 35 years. They found that women with metastatic breast cancer (n=300) at initial diagnosis were 40% less likely to die from the disease if they had the primary tumor surgically removed. Fifty-eight percent did not have surgery, while 42% underwent either a mastectomy or had the tumor removed. The 5-year survival rate for women who had successful surgery was 27%, compared with a survival rate of 16% for women who underwent surgery, but not all of the tumors were completely removed, and 12% for women who did not undergo surgery, Dr. Rapiti reports in the Journal of Clinical Oncology. Among women whose cancer had metastasized to the bone, those who had successful surgery were 80% more likely to be alive 5 years after diagnosis than women who did not have surgery, they found.

bot metastases, uitzaaiïngen, operatie, borstkanker