Abstract:

Locoregional surgical strategies of stage IV breast cancer          ZHAO Yan，ZHENG Xin-yu. Department of Breast Surgery, the First Affiliated Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHENG Xin-yu， E-mail: xyzheng@mail.cmu.edu.cn
Abstract    Systemic therapy is the mainstream treatment of stage IV breast cancer. Current guidelines do not recommend locoregional surgery for Stage Ⅳ breast cancer despite most retrospective studies suggesting a survival benefit. Surgical excision of the primary breast cancer tumor in the presence of synchronous metastatic disease is debated since limited prospective, randomized studies showing that surgical treatment of primary tumors in woman presenting with stage IV disease does not produce an increase in OS. However, the author suggests the situation could be treated individually, initial surgery could be done for those women requiring palliation of symptoms or with impending complications, such as skin ulceration, bleeding and pain if complete local clearance of tumor may be obtained and if other sites of disease are not immediately threatening to life, especially when it is offered in a multimodality treatment program and with the preference of patients.

Key words: stage Ⅳ breast cancer, locoregional surgery, systemic therapy

摘要：

综合治疗是Ⅳ期乳腺癌的主体治疗。尽管大多数回顾性研究提示切除原发病灶可以获得生存获益，然而，目前的指南并不推荐原发病灶的手术切除。现有有限的前瞻性临床研究并未发现总生存获益。所以，存在远处转移的原发病灶切除与否目前存在争议。然而，笔者建议应采用个体化治疗策略。对于那些需要缓解症状或即将出现并发症，如皮肤溃疡、出血和疼痛病人，如果手术能够保证肿瘤局部完全获得清除，而其他转移灶不会立即威胁生命，特别是在多学科讨论的基础上，并征询病人本人及家属的意愿，可以考虑行初始原发病灶姑息性手术切除。

关键词: Ⅳ期乳腺癌, 局部手术, 综合治疗