Primary tumor surgery in patients with de novo stage IV breast cancer: Is there an optimal subgroup for locoregional therapy?

Jennifer H Chen; Zihan Yang; Zixi Yang; Salyna Meas; Abdulkader Almosa; Negar Koupaei; Suprateek Kundu; Anthony Lucci; Shruti Zaveri

doi:10.1016/j.amjsurg.2025.116700

Primary tumor surgery in patients with de novo stage IV breast cancer: Is there an optimal subgroup for locoregional therapy?

Am J Surg. 2026 Jan:251:116700. doi: 10.1016/j.amjsurg.2025.116700. Epub 2025 Oct 29.

Authors

Jennifer H Chen¹, Zihan Yang², Zixi Yang², Salyna Meas³, Abdulkader Almosa³, Negar Koupaei³, Suprateek Kundu², Anthony Lucci³, Shruti Zaveri⁴

Affiliations

¹ Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jennifer.chen2@bcm.edu.
² Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³ Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

PMID: 41197203
DOI: 10.1016/j.amjsurg.2025.116700

Abstract

Background: Surgery remains controversial in de novo stage IV breast cancer. We examined differential impact of surgery on survival outcomes among a surgical cohort of stage IV patients.

Methods: We retrospectively reviewed stage IV patients treated with surgery (2014-2022) and evaluated impact of metastatic disease burden and site on survival outcomes. LRT receipt at metastatic site included surgical resection, ablation, and/or radiation therapy.

Results: Of 165 patients, metastatic burden ranged from 40.0 % (66) solitary [1 lesion], 32.7 % (54) oligometastatic [2-3 lesions], and 27.3 % (45) multiple [≥4 lesions]. Metastatic site consisted of 38.2 % (63) bone-only, 25.5 % (42) soft tissue/lymph node, and 36.4 % (60) visceral. 67.9 % (112) received therapy at a distant metastatic site. Triple negative subtype and multiple metastatic lesions were poor prognostic factors while soft tissue/lymph node involvement was associated with improved prognosis. LRT receipt at metastatic site did not impact survival outcomes.

Conclusions: Long-term survival can be achieved in select patients with de novo stage IV breast cancer treated with multimodal therapy.

Keywords: Metastatic breast cancer; Surgery for de novo stage IV disease; Surgery for metastatic disease; Surgery for primary breast tumor; de novo stage IV breast cancer.

MeSH terms

Adult
Aged
Aged, 80 and over
Breast Neoplasms* / mortality
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Breast Neoplasms* / therapy
Female
Humans
Mastectomy*
Middle Aged
Neoplasm Staging
Retrospective Studies
Survival Rate