Survival Analysis of Palliative Mastectomy for Patients With De Novo Stage IV Breast Cancer: A Single‐Centre Experience

Abstract

ABSTRACT Objective To audit the impact of palliative mastectomy with axillary dissection (PMAD) on the prognosis of patients with de novo stage IV breast cancer in the Pok Oi Hospital (POH), Hong Kong. Methodology We retrospectively reviewed 5377 patients with breast cancer treated in POH between January 2010 and October 2025 and identified 68 patients with de novo stage IV disease who underwent PMAD after systemic therapy. Progression‐free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method and compared by the log‐rank test. Results Median age was 55 years (IQR 48–59 years); 30 patients (44.1%) were premenopausal. Median follow‐up was 31 months (IQR 15–70 months). Common metastatic sites were bone (57.4%), distant lymph nodes (32.4%), liver (22.1%), lung (20.6%), and brain (2.9%). Median OS was 52 months and median PFS was 21 months. Five‐year PFS and OS rates were 31.4% and 47.4%, respectively. Patients with negative margins had a better median PFS than those with positive margins (21 vs. 5 months, p = 0.030, HR 3.188, 95% CI: 1.117–9.100). Patients with negative margins had a better median OS than those with positive margins (52 vs. 13 months, p = 0.013, HR 3.793, 95% CI: 1.319–10.909). Patients with oligometastasis had a trend of better median PFS and OS than those with multiple metastases, although there was no statistical significance (p = 0.141, HR 1.640, 95% CI: 0.849–3.169 and p = 0.055, HR 2.051, 95% CI: 0.986–4.264, respectively). Conclusions PMAD should not be adopted universally for de novo stage IV breast cancer but may be considered selectively—particularly for patients with oligometastasis. Multidisciplinary team collaboration is essential to integrate surgery within individualized, multimodal care plans.