Table 6. Strength of findings in patients with metastatic breast cancer.
| Finding | Summary | Modification | Strength of evidence |
|---|---|---|---|
| Survival | Hormone- and HER2-naïve patients have a statistically and temporally significant survival advantage over resistant receptor patients. | Upgrade: large effect (source: nonsurgical studies, Sciubba et al1 study) | Moderate |
| DFI and a greater degree of axillary lymph node invasion have a statistically and temporally significant negative impact on survival. | Upgrade: large effect (source: large nonsurgical studies) | Moderate | |
| Single-modality postoperative adjuvant therapy (compared with dual therapy: radiation and chemotherapy) has a statistically and temporally significant negative impact on survival. | Source: Zadnik et al4 only | Low | |
| Visceral metastasis, surgical complications, presence of other skeletal metastasis, presence of cervical metastasis, and age have a statistically and temporally significant negative impact on survival. | Downgrade: inconsistent results across studies, for age different cutoffs are used (Sciubba et al1 vs. Zadnik et al4 vs. nonsurgical results) | Insufficient | |
| Pain outcome | Surgery provides pain relief in over 75% of cases with preoperative pain. | Based on 85 patients (see Table 3) | Low |
| Cement augmentation procedures provide a high rate of pain relief (>90%). | Downgrade: small sample size (19 patients) | Insufficient | |
| Neurologic outcome | Surgery improves neurologic function in over 50% of cases with preoperative deficit. | Upgrade: large effect (based on 168 patients) | Moderate |
| Surgery treatment has ∼5% risk of neurologic deterioration. | Upgrade: large effect (based on 169 patients) | Moderate | |
| Local tumor control | Surgical resection results in local tumor control rates of >90% for up to 12 mo. | Based on 129 patients | Low |
Note: High indicates majority of articles level I or II; low indicates majority of articles level III or IV. Upgrade means large effect or gradient response; downgrade means inconsistence, imprecision of effect, indirect evidence, publication bias.