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<p>De novo stage IV breast cancer is an aggressive subtype characterized by distant metastases at diagnosis, comprising approximately 6% of all breast cancer cases. While systemic therapy is the primary treatment, the prognostic role of primary tumor surgery remains controversial. This study aimed to evaluate the impact of surgery on survival using a large, population-based cohort. A total of 34,164 patients diagnosed with metastatic breast cancer between 2010-2022 were identified from the SEER database. Patients were grouped based on surgical status, and 1:1 propensity score matching was applied to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using Kaplan-Meier and Cox regression methods. Nomograms were developed for individualized survival prediction. Surgery was associated with significantly better 5- and 10-year OS (41.6% vs. 30.2%; 24.3% vs. 13.3%) and CSS(47.5% vs. 34.8%; 30.9% vs. 18.0%) (p&lt;0.001). Multivariate analysis showed a 51% higher mortality risk without surgery for OS and 57% for CSS. Survival benefit was most notable in HR(+)/HER2(+) and HR(–)/HER2(+) subtypes.&#xa0;Nomograms showed strong predictive accuracy (AUC &gt; 0.73; C-index ~0.74). Primary tumor surgery may represent a favorable prognostic factor in carefully selected patients, and the proposed nomograms enable individualized survival estimation to support multidisciplinary decision-making.</p>

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Survival Impact of Primary Tumor Surgery in De Novo Stage IV Breast Cancer: A Propensity-Matched Cohort Study with Prognostic Nomogram Development

  • 期刊论文

  • 发表日期：

    2026年2月3日

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  • Bilal Turan,
  • Ahmet Necati Sanli,
  • Deniz Esin Tekcan Sanli,
  • Isa Karaca

摘要

De novo stage IV breast cancer is an aggressive subtype characterized by distant metastases at diagnosis, comprising approximately 6% of all breast cancer cases. While systemic therapy is the primary treatment, the prognostic role of primary tumor surgery remains controversial. This study aimed to evaluate the impact of surgery on survival using a large, population-based cohort. A total of 34,164 patients diagnosed with metastatic breast cancer between 2010-2022 were identified from the SEER database. Patients were grouped based on surgical status, and 1:1 propensity score matching was applied to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using Kaplan-Meier and Cox regression methods. Nomograms were developed for individualized survival prediction. Surgery was associated with significantly better 5- and 10-year OS (41.6% vs. 30.2%; 24.3% vs. 13.3%) and CSS(47.5% vs. 34.8%; 30.9% vs. 18.0%) (p<0.001). Multivariate analysis showed a 51% higher mortality risk without surgery for OS and 57% for CSS. Survival benefit was most notable in HR(+)/HER2(+) and HR(–)/HER2(+) subtypes. Nomograms showed strong predictive accuracy (AUC > 0.73; C-index ~0.74). Primary tumor surgery may represent a favorable prognostic factor in carefully selected patients, and the proposed nomograms enable individualized survival estimation to support multidisciplinary decision-making.