Importance: Management of the @entity5 site in @entity1 with metastatic @entity0 remains controversial. Objective: To evaluate the patterns of receipt of initial breast surgery for female @entity1 with @entity0 in the United States, with particular attention to @entity1 who survived at least 10 years. Design, Setting, and @entity1 : A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) program. Female @entity1 diagnosed as having @entity0 between 1988 and 2011 and who did not receive radiation therapy as part of the first course of treatment were included (N   =   21   372). Kaplan-Meier estimates of median survival and descriptive statistics were used to compare @entity1 and @entity5 characteristics by receipt of breast surgery at diagnosis. A Royston-Parmar survival model and logistic regression analysis assessed demographic and clinical factors associated with survival and prolonged survival (of at least 10 years). Main Outcomes and Measures: Differences in survival, particularly survival of at least 10 years, by receipt of initial surgery to the @entity5 . Results: Among the 21   372 @entity1 , the median survival increased from 20 months (1988-1991) to 26 months (2007-2011). During this time, the rate of surgery declined (odds ratio [OR], 0.16; 95% CI, 0.12-0.21). Even so, receipt of surgery was associated with improved survival in multivariate analysis, which controlled for @entity1 and clinical characteristics, along with time period (hazard ratio, 0.60; 95% CI, 0.57-0.63). For @entity1 diagnosed as having @entity5 before 2002 (n   =   7504), survival of at least 10 years was seen in 9.6% (n   =   353) and 2.9% (n   =   107) of those who did and did not receive surgery, respectively (OR, 3.61; 95% CI, 2.89-4.50). In multivariate analysis, survival of at least 10 years was associated with receipt of surgery (odds ratio, 2.80; 95% CI, 2.08-3.77), hormone receptor-positive disease (OR, 1.76; 95% CI, 1.25-2.48), older age (OR, 0.41; 95% CI, 0.32-0.54), larger @entity5 size (OR, 0.37; 95% CI, 0.27-0.51), marital status of being separated at the time of diagnosis (OR, 0.67; 95% CI, 0.51-0.88), and more recent year of diagnosis (OR, 1.43; 95% CI, 1.02-1.99). Conclusions and Relevance: Survival in @entity0 has improved and is increasingly of prolonged duration, particularly for some @entity1 undergoing initial breast surgery. As systemic therapy advances provide better control of distant disease in @entity0 , and as @entity1 present with lower distant disease burdens, these findings on initial surgery to the @entity5 may be of importance.

Initial Surgery and Survival in Stage IV XXXX in the United States, 1988-2011.

@entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'cancer', 'primary tumor'] @entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient', 'Participants'] @entity0 :: ('MESH:D001943', 'Disease') :: ['stage IV breast cancer', 'breast cancer']
@entity0 :: (MESH:D001943,Disease) :: ['Breast Cancer']
