Updated evidence of primary tumor resection in stage Ⅳ breast cancer:a systematic review and meta-analysis

作     者：Zacharoula Sidiropoulou Ana Rita Martins Patricia Amaral Vasco Cardoso Sofia Boligo Vasco Fonseca Zacharoula Sidiropoulou;Ana Rita Martins;Patricia Amaral;Vasco Cardoso;Sofia Boligo;Vasco Fonseca

作者机构：Breast UnitGeneral SurgeryCentro Hospitalar Lisboa OcidentalLisboa 2790-134Portugal Medical OncologyCentro Hospitalar Lisboa OcidentalLisboa 2790-134Portugal 

出 版 物：《Journal of Cancer Metastasis and Treatment》 (癌症转移与治疗（英文版）)

年 卷 期：2023年第9卷第1期

页      面：1-19页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：General Surgery Department Massab Khaira 

主　　题：PTR primary tumor resection breast cancerⅣstage breast cancer overall survival metastatic disease 

摘      要：Background:In stage Ⅳ breast cancer,surgical resection of the primary tumor was traditionally performed solely to palliate symptoms such as bleeding,infection,or *** ongoing discussion has shown that there are many research gaps in the current literature and differences in clinical ***,this systematic review and meta-analysis was designed to evaluate how primary tumor resection(PTR)affects the overall survival(OS)of patients with stage Ⅳ breast ***:A thorough literature search was completed using different databases(PubMed,Google Scholar,Scopus,ScienceDirect,and Cochrane Library)to find papers contrasting PTR with no *** quality of research articles was evaluated using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale(NOS).Review Manager 5.4 was used to determine how much demographic and clinical factors contribute to heterogeneity through subgroup and meta-regression ***:Data derived from 44 observational studies(OS)and four randomized controlled trials(RCTs)including 227,889 patients were *** all cases,150,239 patients were included in the non-PTR group,and 70,795 patients in the PTR group(37 observational studies and 4 randomized control trials).The pooled outcomes of four RCT studies(Hazard Ratio(HR)=1.03,95%CI:0.67-1.58;I2=88%;P0.0001;chi-square 24.57)favor *** pooled outcomes of 43 observational studies showed PTR significantly improved OS(HR=0.66,95%CI:0.61-0.71;I2=87%;P0.00001;chi-square 359.12).Additionally,subgroup analysis that compared PTR with non-PTR in patients with stage IV breast cancer for progression free-survival(HR=0.89,95%CI:0.62-1.28;P=0.03;I2=71%)and locoregional progression-free survival(LPFS)(HR=0.33,95%CI:0.14-0.74;P=0.0004;I^(2)=87%)was found to be significant favoring the PTR *** progression-free survival(DPFS)had a non-significant relationship(HR=0.42,95%CI:0.29-0.60;P=0.12;I^(2)=53%),while overall,there was a significant relationship(HR=0.49,95%CI:0