The Role of Surgery in the Upfront Treatment of Metastatic Breast Cancer

Breast cancer is the leading cause of cancer-related mortality among women worldwide, with an incidence of 49.5 per 100,000 women globally and 45.5 per 100,000 in Morocco. Metastatic breast cancer at the time of diagnosis, although representing a small proportion of all breast cancer cases (3%-6% in high-income countries), remains a major clinical challenge. This study, conducted at Hassan II University Hospital in Fes, Morocco, aimed to evaluate the clinical outcomes of stage IV breast cancer patients who underwent surgery after neoadjuvant chemotherapy. A retrospective analysis was performed on 40 patients diagnosed with metastatic breast cancer between January 2015 and December 2021. The study focused on demographic, clinical, and pathological characteristics, including molecular classification, hormone receptor status, HER2 expression, and tumor histology. The patients received various treatment modalities, including chemotherapy, hormone therapy, and Herceptin, with responses monitored through imaging and histological evaluation. The study found that neoadjuvant chemotherapy resulted in favorable tumor responses, with 10 patients achieving a complete response and 16 showing partial responses. Surgery, despite the metastatic nature of the disease, was associated with improved progression-free survival (PFS) when combined with lymph node dissection and a histological response greater than 50%. Univariate analysis revealed that triple-negative breast cancer and lack of surgical lymph node dissection were associated with shorter PFS. The median PFS was 24.95 months, with a 3-year PFS rate of 23.3%. These findings suggest that in select patients with metastatic breast cancer, surgery following systemic chemotherapy may provide survival benefits, especially when coupled with favorable histological responses and lymph node involvement. The study underscores the potential of personalized treatment strategies and further investigation into local therapies ...