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Abstract
INTRODUCTION:
Improvement in overall survival (OS) by locoregional treatment (LRT) of the primary tumor in de novo metastatic breast cancer (MBC) patients remains controversial.

OBJECTIVE:
The aim of our study was to evaluate the impact of LRT on OS in a large retrospective cohort of de novo MBC patients, with regard to immunohistochemical characteristics and pattern of metastatic dissemination.

METHODS:
We conducted a multicentric retrospective study of patients diagnosed with de novo MBC selected from the French Epidemiological Strategy and Medical Economics MBC database (NCT03275311) between 2008 and 2014. Overall, 4276 women were included in the study. LRT comprised either radiotherapy, surgery, or both.

RESULTS:
LRT was used in 40% of patients. Compared with no LRT, patients who received LRT were younger (p < 0.0001) and were more likely to have only one metastatic site (p < 0.0001) or bone-only metastases (p < 0.0001). LRT was associated with a significantly better OS based on landmark multivariate analysis at 1-year (hazard ratio 0.65, 95% confidence interval 0.55-0.76, p < 0.001). Similar results were observed in all sensitivity analyses, including propensity score matching. In subgroup analysis, LRT was associated with better OS in patients with hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative (61.6 vs. 45.9 months, p < 0.001) and HER2-positive tumors (77.2 vs. 52.6 months, p = 0.008), but not in triple-negative tumors (19 vs. 18.6 months, p = 0.54), and was also associated with a reduction in the risk of death in visceral metastatic patients (p < 0.001).

CONCLUSIONS:
LRT was associated with a significantly better OS in de novo MBC patients, including patients with visceral involvement at diagnosis; however, LRT did not impact OS in triple-negative MBC.

Author information

Pons-Tostivint E1, Kirova Y2, Lusque A3, Campone M4, Geffrelot J5, Mazouni C6, Mailliez A7, Pasquier D8, Madranges N9, Firmin N10, Crouzet A11, Gonçalves A12, Jankowski C13, De La Motte Rouge T14, Pouget N15, de La Lande B16, Mouttet-Boizat D17, Ferrero JM18, Uwer L19, Eymard JC20, Mouret-Reynier MA21, Petit T22, Robain M23, Filleron T3, Cailliot C24, Dalenc F25.
1
Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse Cedex 09, France.
2
Department of Radiation Oncology, Curie Institute, Paris, France.
3
Department of Biostatistics, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.
4
Department of Medical Oncology, René Gauducheau Center, Institut de Cancérologie de l'Ouest (ICO), Saint-Herblain, France.
5
Department of Radiation Oncology, François Baclesse Center, Caen, France.
6
Department of Surgery, Gustave Roussy Institute, Villejuif, France.
7
Department of Medical Oncology, Oscar Lambret Center, Lille, France.
8
Department of Radiation Oncology, Oscar Lambret Center, Lille, France.
9
Department of Medical Oncology, Bergonié Institute, Bordeaux, France.
10
Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France.
11
Department of Surgery, Henri Becquerel Center, Rouen, France.
12
Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France.
13
Department of Surgery, Georges-François Leclerc Center, Dijon, France.
14
Department of Medical Oncology, Eugène Marquis Center, Rennes, France.
15
Department of Surgery, René Huguenin Centre, Curie Institute, Saint-Cloud, France.
16
Department of Radiation Oncology, René Huguenin Centre, Curie Institute, Saint-Cloud, France.
17
Department of Surgery, Curie Institute, Paris, France.
18
Department of Medical Oncology, Antoine Lacassagne Cancer Center, Nice, France.
19
Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France.
20
Department of Medical Oncology, Jean Godinot Institute, Reims, France.
21
Department of Medical Oncology, Jean Perrin Center, Clermont-Ferrand, France.
22
Department of Medical Oncology, Paul Strauss Center, Strasbourg, France.
23
Biostatistics Unit, Curie Institute, PSL Research University, Paris, France.
24
Department of Research and Development, R&D Unicancer, Paris, France.
25
Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse Cedex 09, France. dalenc.florence@iuct-oncopole.fr.