通过5例首诊Ⅳ期乳腺癌病例及文献复习，探讨手术治疗时机选择及疗效。

回顾分析2012年6月至2018年11月于北京大学首钢医院经全身治疗联合局部手术治疗的首诊Ⅳ期乳腺癌患者5例，观察其疗效及生存质量，并回顾分析相关文献。

5例患者在全身治疗有效并维持8~15个月后行乳腺原发灶和/或转移灶手术，均达到R0切除，术后均接受了全身治疗，其中1例患者因肝转移死亡，其余患者均生存，无局部复发生存期6~72个月，无远处转移进展生存期6~48个月，总生存期25~72个月。生存质量调查结果显示，从功能领域来看，患者躯体角色情绪社会功能普遍较好；症状领域中，患者出现的轻微症状考虑与肿瘤不相关，部分为内分泌药物不良反应，1例老年患者出现认知功能下降。

在有效全身治疗的情况下，充分评估疾病负荷、发展进程，结合患者体力状况和个人意愿，适时采取局部治疗措施，可提高生存质量，改善生存。

To analyze the clinical data of five cases of newly diagnosed stage Ⅳ breast cancer and perform a literature review, in order to analyze the timing and efficacy of surgical treatment.

A retrospective analysis was performed on five patients with newly diagnosed stage Ⅳ breast cancer who received systemic treatment combined with locoregional operation from June 2012 to November 2018 at Peking University Shougang Hospital. The efficacy and quality of life were assessed, and the relevant literature was reviewed.

After systemic treatment was effective and maintained for 8-15 months, the five patients underwent surgery for primary breast lesions and/or metastases, and all of them achieved R0 resection. All patients received systemic treatment after operation. One of the patients died of liver metastasis, while the others survived. The local-regional failure free survival was 6-72 months, the distance disease progression free survival was 6-48 months, and the overall survival was 25-72 months. The quality of life in function domain, including patients' physical role and emotional and social function, was generally better. In the domain of symptoms, the mild symptoms of the patients were not related to the tumor, some were adverse reactions of endocrine therapy, and one elderly patient had decreased cognitive function.

Under optimal systemic treatment, with consideration of the physical condition and individual needs of our patients, combined with timely local treatment measures and a thorough evaluation of the disease load and development process, patients' quality of life and survival rates can be improved.