Breast cancer research and treatment · 2026
Surgical management in HER2 + de novo metastatic breast cancer: disease progression and survival.
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Brennan Malia, Javid Sara H, Flanagan Meghan R, Schmicker Robert, Gwin William R, Fleuret Sophie, Palmquist Emily
Аннотация
PURPOSE: Advancements in human epidermal growth factor (HER)-targeted therapy have significantly improved survival in patients with de novo metastatic HER-2 positive (HER2+) breast cancer (dnMBC). The role of breast surgery is debated. We examined which HER2 + dnMBC patients undergo surgery and compared outcomes to systemic therapy alone.
METHODS: We performed a single institution retrospective review of patients with HER2 + dnMBC diagnosed 2011-2023. Data included demographics, clinicopathologic details, treatment information, local and distant disease progression, and survival outcomes. Analyses included logistic regression, Kaplan Meier, and Cox proportional hazards models.
RESULTS: The study included 103 patients. Of these, 42.7% underwent breast surgery (70.5% mastectomy, 29.5% lumpectomy). Of these, 72.7% underwent axillary surgery (38.6% axillary lymph node dissection, 27.3% sentinel lymph node biopsy, 6.8% targeted axillary dissection). The median age at diagnosis was 48 years (surgery) and 56 years (no surgery) (p = 0.10). The surgery group had lower number of metastatic sites (1.3 vs. 1.9, p = 0.003) and exhibited higher rates of local disease progression pre-operatively (39% vs. 23.5%, p = 0.05). Post-operatively, there was no significant difference in local disease progression (17.1% vs. 23.5%, p = 0.42). After adjusting for age, sites of metastases, and number of metastatic sites, those who underwent surgery had improved overall survival (HR 0.33 (0.14-0.77), p = 0.02).
CONCLUSION: Patients with HER2 + dnMBC with lower metastatic disease burden and local disease progression were more likely to undergo breast surgery. There was no significant difference in local disease control post-operatively. The significant association between surgery and improved survival must be interpreted with caution due selection bias in this retrospective study.
METHODS: We performed a single institution retrospective review of patients with HER2 + dnMBC diagnosed 2011-2023. Data included demographics, clinicopathologic details, treatment information, local and distant disease progression, and survival outcomes. Analyses included logistic regression, Kaplan Meier, and Cox proportional hazards models.
RESULTS: The study included 103 patients. Of these, 42.7% underwent breast surgery (70.5% mastectomy, 29.5% lumpectomy). Of these, 72.7% underwent axillary surgery (38.6% axillary lymph node dissection, 27.3% sentinel lymph node biopsy, 6.8% targeted axillary dissection). The median age at diagnosis was 48 years (surgery) and 56 years (no surgery) (p = 0.10). The surgery group had lower number of metastatic sites (1.3 vs. 1.9, p = 0.003) and exhibited higher rates of local disease progression pre-operatively (39% vs. 23.5%, p = 0.05). Post-operatively, there was no significant difference in local disease progression (17.1% vs. 23.5%, p = 0.42). After adjusting for age, sites of metastases, and number of metastatic sites, those who underwent surgery had improved overall survival (HR 0.33 (0.14-0.77), p = 0.02).
CONCLUSION: Patients with HER2 + dnMBC with lower metastatic disease burden and local disease progression were more likely to undergo breast surgery. There was no significant difference in local disease control post-operatively. The significant association between surgery and improved survival must be interpreted with caution due selection bias in this retrospective study.