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Breast Cancer Treatment Studies / Breast Lesions and Carcinomas · Journal article
Frontiers in Oncology · September 7, 2026
A consensus or society position rather than new primary data.
This systematic review finds a discordance between retrospective data—which suggest locoregional surgery improves survival in de-novo stage IV breast cancer—and prospective randomized trials, which have not demonstrated benefit beyond systemic therapy alone. The review concludes routine locoregional surgery is not recommended for most patients, with a potential exception for those with bone-only metastases, and calls for further prospective data.
Systematic review of retrospective cohort studies, meta-analyses, and prospective randomized controlled trials. Patients with de-novo stage IV breast cancer (metastatic disease present at initial diagnosis). Intervention: Locoregional (primary tumor) surgical resection. Compared with: Systemic therapy alone (primary systemic therapy for palliative care).
Most retrospective studies and meta-analyses report improved prognosis with primary breast surgery in de-novo stage IV disease at diagnosis Prospective randomized controlled trials have consistently failed to demonstrate that locoregional surgery provides additional survival benefits beyond systemic therapy alone Women undergoing surgery in retrospective cohorts were younger, had smaller primary tumors, fewer comorbidities, and lower metastatic burden—indicating significant selection bias
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should not routinely recommend locoregional surgery for most patients with de-novo stage IV breast cancer, as prospective evidence does not support survival benefit beyond systemic therapy. An exception may be considered for patients with bone-only metastatic disease, pending further prospective trials.
A systematic review synthesizing retrospective and prospective evidence to inform clinical decision-making about locoregional surgery in de-novo stage IV breast cancer, concluding routine surgery is not recommended except for bone-only metastases.
As stated by the source record.
Clinicians should not routinely recommend locoregional surgery for most patients with de-novo stage IV breast cancer, as prospective evidence does not support survival benefit beyond systemic therapy. An exception may be considered for patients with bone-only metastatic disease, pending further prospective trials.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Purpose Breast cancer is the most common malignancy among women worldwide. A notable subset of patients presents with de-novo stage IV breast cancer at initial diagnosis, meaning metastatic lesions are already present. These patients typically receive primary systemic therapy aimed at palliative care, with locoregional treatment remaining controversial. Although numerous retrospective studies have suggested that resection of the primary tumor may improve survival, prospective randomized trials have not demonstrated a clear benefit, and routine surgical intervention is not generally advocated. This paper aims to review and discuss the research progress regarding locoregional surgical treatment for de-novo stage IV breast cancer. Methodology Recent retrospective and prospective studies on locoregional surgery for de-novo stage IV breast cancer were searched, with a focus on prospective randomized controlled trials (RCTs). The collected evidence was reviewed to evaluate the role of local surgery in this patient population. Results Most retrospective studies and meta-analyses report that primary breast surgery is associated with improved prognosis when stage IV disease is first diagnosed. However, significant selection bias exists in these data. Women who undergo surgery tend to be younger, have smaller primary tumors, fewer comorbidities, and lower metastatic burden—particularly fewer visceral metastases. They are also more likely to receive higher-quality overall care. These factors suggest that surgeons preferentially select patients with a better expected prognosis for surgery. In contrast, prospective randomized trials have consistently failed to demonstrate that locoregional surgery provides additional survival benefits beyond systemic therapy alone. Consequently, routine locoregional surgical treatment is not recommended for most patients with de-novo stage IV breast cancer. Nevertheless, a notable exception exists for patients with bone-only metastases. Conclusion Although retrospective analyses support a survival advantage from locoregional surgery in de-novo stage IV breast cancer, prospective RCTs have not confirmed a benefit for the general patient population. However, locoregional surgery does appear to offer survival benefits for patients with bone-only metastases. Further prospective clinical trial data are certainly needed to better define the value of locoregional surgery in de-novo stage IV breast cancer.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.