{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T02:41:15Z","timestamp":1774147275740,"version":"3.50.1"},"reference-count":64,"publisher":"Harborside Press, LLC","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients with de novo metastatic breast cancer (MBC) constitute a heterogeneous group with different clinicopathologic characteristics and survival outcomes. Despite controversy regarding its prognostic value, primary tumor surgery may improve survival for selected patients. <jats:bold>Patients and Methods:<\/jats:bold> Patients with de novo MBC were identified using the SEER database and were then divided randomly into training and validation sets. A Fine-Gray competing risks model was developed to identify the variables associated with increased cancer-specific mortality in the training set. The M1 subdivision system was established based on the independent prognostic factors. Cumulative incidence curves were estimated and compared using Gray\u2019s test. <jats:bold>Results:<\/jats:bold> Involvement of brain or liver and number of metastatic sites were identified as independent prognostic factors in multivariate analysis. The M1 category was subdivided into 3 subcategories: M1a, single site involvement except brain and liver; M1b, liver involvement only, or multiple site involvement except brain and liver; and M1c, brain involvement regardless of number of metastatic sites, or liver and other sites involvement except brain (M1b vs M1a: subdistribution hazard ratio [SHR], 1.48; 95% CI, 1.29\u20131.68; M1c vs M1a: SHR, 2.45; 95% CI, 2.18\u20132.75). Patients with the M1a subtype benefited most from primary tumor surgery in the adjusted competing risks model (M1a: SHR, 0.57; 95% CI, 0.48\u20130.67, M1b: SHR, 0.62; 95% CI, 0.47\u20130.83, and M1c: SHR, 0.59; 95% CI, 0.44\u20130.80), whereas benefits conferred by treatment with chemotherapy alone increased with the upstaging of metastatic disease (M1a: SHR, 0.72; 95% CI, 0.62\u20130.83, M1b: SHR, 0.54; 95% CI, 0.44\u20130.68, and M1c: SHR, 0.53; 95% CI, 0.45\u20130.61). <jats:bold>Conclusions:<\/jats:bold> Subdivision of M1 stage facilitates prognosis prediction and treatment planning for patients with de novo MBC. Treatment offered should be decided in a coordinated multidisciplinary setting. Primary tumor surgery may play an important role in the management of selected patients.<\/jats:p>","DOI":"10.6004\/jnccn.2019.7332","type":"journal-article","created":{"date-parts":[[2019,12,5]],"date-time":"2019-12-05T20:06:32Z","timestamp":1575576392000},"page":"1521-1528","source":"Crossref","is-referenced-by-count":21,"title":["Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor 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