Palabras clave
cirugía
supervivencia
tratamiento
Cómo citar
Resumen
Introducción: El manejo sistémico es el pilar del tratamiento en las pacientes con cáncer de mama metastásico al debut. Sin embargo, la terapia conjunta (sistémica con cirugía local/locorregional) es objeto de investigación para determinar si ofrece un beneficio adicional en los resultados oncológicos. Los ensayos clínicos aleatorizados tienen reportes contradictorios en cuanto a supervivencia global, mientras que los estudios retrospectivos muestran un impacto favorable. Esta investigación tuvo como objetivo describir la supervivencia global y la supervivencia libre de progresión de pacientes con carcinoma de mama metastásico al debut, tratadas con terapia sistémica exclusiva o terapia conjunta. Materiales y método: Estudio retrospectivo de una cohorte de pacientes con carcinoma de mama metastásico al debut de una clínica de referencia oncológica. Se evaluaron dos grupos de manejo: con terapia sistémica exclusiva vs. terapia conjunta. Los resultados principales evaluados fueron la supervivencia libre de progresión y la supervivencia global, calculados mediante las funciones de supervivencia de Kaplan-Meier y ajustados a las variables confusoras con modelos de Cox. Resultados: Recibieron terapia sistémica exclusiva 174 pacientes y 88 pacientes, terapia conjunta. La mediana de seguimiento fue de 58,38 meses; la supervivencia libre de progresión fue de 38,56 meses en el grupo de terapia sistémica exclusiva vs. 72,25 meses para el grupo de terapia conjunta. La supervivencia global fue de 42,4 meses (IC 95 % 33,23-51,56) en terapia sistémica exclusiva vs. 82,33 (IC 95 % 62,1-102,55) en terapia conjunta, ambos resultados estadísticamente significativos para el grupo quirúrgico. Conclusión: En pacientes con carcinoma de mama metastásico al debut, la supervivencia global y la supervivencia libre de progresión fueron mejores en los tratados con terapia conjunta que en los manejados con terapia sistémica exclusiva.
Citas
Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S, et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: An open-label randomised controlled trial. Lancet Oncol. 2015;16(13): 1380-8. https://doi.org/10.1016/S1470-2045(15)00135-7
Sabel M, Truong P, The role of local therapies in metastatic breast cancer, UpToDate, 2022, Inc.
Gradishar W, Anderson B, Abraham J, Aft R, Agnese D, Allison K, et al. Breast cancer version 4.2023. J Natl Compr Canc Netw. 2023;21(6): 594-608. https://doi.org/10.6004/jnccn.2023.0031.
Gera R, Chehade H, Wazir U, Tayeh S, Kasem A, Mokbel K. Locoregional therapy of the primary tumour in de novo stage IV breast cancer in 216 066 patients: A meta-analysis. Sci. Rep. 2020;10(1): 1-11. https://doi.org/10.1038/s41598-020-59908-1
Fitzal F, Bjelic-Radisic V, Knauer M, Steger G, Hubalek M, Balic M, et al. Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg. 2019;269(6): 1163-69. https://doi.org/10.1097/SLA.0000000000002771
Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci, A, et al. Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: Protocol MF07-01. Ann. Surg. Oncol. 2018;25(11): 3141-149. https://doi.org/10.1245/s10434-018-6494-6
Khan SA, Zhao F, Goldstein LJ, Cella D, Basik M, Golshan M, et al. Early local therapy for the primary site in de novo stage IV breast cancer: Results of a randomized clinical trial (E2108). J Clin Oncol. 2022;40(9): 978-87. https://doi.org/10.1200/JCO.21.02006
Huang Z, Tan Q, Qin Q, Mo Q, Wei C. Impact of primary site surgery on survival of patients with de novo stage IV breast cancer. Cancer Manag Res. 2021;13: 319-27. https://doi.org/10.2147/CMAR.S280470
Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol. 2006;13(6):776-82. https://doi.org/10.1245/ASO.2006.03.033
Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol. 2006;24(18):2743-9. https://doi.org/10.1200/JCO.2005.04.2226
Kim KN, Qureshi MM, Huang D, Ko NY, Cassidy M, Oshry L, et al. The impact of locoregional treatment on survival in patients with metastatic breast cancer: A National Cancer Database Analysis. Clin Breast Cancer. 2020;20(2): e200-13. https://doi.org/10.1016/j.clbc.2019.12.010
Pons-Tostivint E, Kirova, Y, Lusque A. Campone M, Geffrelot J, Mazouni C, et al. Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study: A Propensity Score-Matched Analysis. Ann Surg Oncol. 2019;26: 356-65. https://doi.org/10.1245/s10434-018-6831-9
Hortobagyi G, Conolly J, D’orsi C, Edge S, Mittendorf E, Rugo H, et al. Abreast. En: Amin M, Edge S, Greene F, Byrd D, Brookland R, Kay M. (Eds), AJCC Cancer Staging Manual, American College of Surgeon, 8th ed. Chicago: Springer; 2017, pp. 589-636.
Díaz S, Briceño X, Puerto LJ, Lehmann C, Orozco MC, Guzmán LH, et al Factors Associated with Time to Progression and Overall Survival in Patients with De Novo Metastatic Breast Cancer: A Colombian Cohort. Oncologist. 2022 Mar 4;27(2): e142-50. https://doi.org/10.1093/oncolo/oyab023
Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery. 2002;132(4): 620-6. https://doi.org/10.1067/msy.2002.127544
Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol. 2006;24(18): 2743-9. https://doi.org/10.1200/JCO.2005.04.2226
Blanchard D, Shetty P, Hilsenbeck S, Elledge R. Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg. 2008;247: 732-8. https://doi.org/10.1097/SLA.0b013e3181656d32
Thomas A, Khan SA, Chrischilles EA, Schroeder MC. Initial Surgery and Survival in Stage IV Breast Cancer in the United States, 1988-2011. JAMA Surg. 2016;151(5): 424-31. https://doi.org/10.1001/jamasurg.2015.4539
Jiménez J, Sánchez B, Machuca P, Navarro J, Dueñas B. Tratamiento quirúrgico del tumor primario en pacientes con cáncer de mama en estadio IV. Cir Esp. 2015;93(6): 375-80. https://doi.org/10.1016/j.ciresp.2014.09.005
Tosello G, Torloni MR, Mota BS, Neeman T, Riera R. Breast surgery for metastatic breast cancer. Cochrane Database Syst Rev. 2018;3(3): CD011276. https://doi.org/10.1002/14651858.CD011276.pub2
Bermas HR, Khan SA. Local therapy for the intact breast primary in the presence of metastatic disease. En: Bland KI, Copeland EM (Eds). The breast, comprehensive management of benign and malignant disease, 4.a ed., vol. 2. Philadelphia: Elsevier Health Sciences; 2009, pp. 1211-21. https://doi.org/10.1016/B978-1-4160-5221-0.00074-7
Ren Z, Li Y, Hameed O, Siegal GP, Wei S. Prognostic factors in patients with metastatic breast cancer at the time of diagnosis. Pathol Res Pract. 2014;210(5): 301-6. https://doi.org/10.1016/j.prp.2014.01.008
Ranji P, Salmani Kesejini T, Saeedikhoo S, Alizadeh AM. Targeting cancer stem cell-specific markers and/or associated signaling pathways for overcoming cancer drug resistance. Tumour Biol. 2016;37(10): 13059-75. https://doi.org/10.1007/s13277-016-5294-5
Bauernhofer T, Zenahlik S, Hofmann G, Balic M, Resel M, Pirchmoser R, et al. Association of disease progression and poor overall survival with detection of circulating tumor cells in peripheral blood of patients with metastatic breast cancer. Oncol Rep. 2005;13: 179-84. https://pubmed.ncbi.nlm.nih.gov/15643496/
Bidard FC, Vincent-Salomon A, Sigal-Zafrani B, Diéras V, Mathiot C, Mignot L, et al. Prognosis of women with stage IV breast cancer depends on detection of circulating tumor cells rather than disseminated tumor cells. Ann Oncol. 2008;19: 496-500. https://doi.org/0.1093/annonc/mdm507
Rashid OM, Nagahashi M, Ramachandran S, Graham L, Yamada A, Spiegel S, et al. Resection of the primary tumor improves survival in metastatic breast cancer by reducing overall tumor burden. Surgery. 2013;153(6): 771-8. https://doi.org/10.1016/j.surg.2013.02.002
Sandri MT, Zorzino L, Cassatella MC, Bassi F, Luini A, Casadio C, et al. Changes in circulating tumor cell detection in patients with localized breast cancer before and after surgery. Ann Surg Oncol. 2010;17(6): 1539-45. https://doi.org/10.1245/s10434-010-0918-2
Andergassen U, Zebisch M, Kolbl AC, König A, Heublein S, Schröder L, et al. Real-time qPCR-based detection of circulating tumor cells from blood samples of adjuvant breast cancer patients: a preliminary study. Breast Care (Basel). 2016;11: 194-8. https://doi.org/10.1159/000447041
Schindlbeck C, Andergassen U, Jueckstock J, Rack B, Janni W, Jeschke U. Disseminated and circulating tumor cells in bone marrow and blood of breast cancer patients: properties, enrichment, and potential targets. J Cancer Res Clin Oncol. 2016;142: 1883-95. https://doi.org/10.1007/s00432-016-2118-3
Balic M, Lin H, Young L, Hawes D, Giuliano A, McNamara G, et al. Most early disseminated cancer cells detected in bone marrow of breast cancer patients have a putative breast cancer stem cell phenotype. Clin Cancer Res. 2006;12: 5615-21. https://doi.org/10.1158/1078-0432.CCR-06-0169
Santa-Maria CA, Gradishar WJ. Changing treatment paradigms in metastatic breast cancer: lessons learned. JAMA Oncol. 2015;1(4): 528-34. https://doi.org/10.1001/jamaoncol.2015.1198
Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD. Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res. 2010;161(1): 83-8. https://doi.org/10.1016/j.jss.2008.12.030
Cady B, Nathan NR, Michaelson JS, Golshan M, Smith BL. Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol. 2008;15(12):3384-95. https://doi.org/10.1245/s10434-008-0085-x
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Derechos de autor 2024 Fernanda Bravo, Elsa Maria Vásquez Trespalacios, Arnon Oviedo, Fernando Herazo, Javier Cuello