Resection of liver metastases from breast cancer: a multicentre analysis

Abstract

Background Surgery is becoming more practical and effective than conservative treatment in improving the poor outcomes of patients with breast cancer liver metastasis (BCLM). However, there is no generally acknowledged set of standards for identifying BCLM candidates who will benefit from surgery. Methods Between January 2011 and September 2018, 67 female BCLM patients who underwent partial hepatectomy were selected for analysis in the present study. Prognostic factors after hepatectomy were determined. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and intrahepatic recurrence-free survival (IHRFS). Results The 1-, 3-and 5-year OS of patients treated with surgery was 93.5%, 73.7% and 32.2%, respectively, with a median survival time of 57.59 months. The Pringle manoeuvre [hazard radio (HR) = 0.117, 95% CI0.015-0.942, p = 0.044] and an increased interval between breast surgery and BCLM diagnosis (HR0.178, 95% CI 0.037-0.869, p = 0.033) independently predicted improved overall survival for BCLM patients. The 1-, 2-and 3-year IHRFS of patients who underwent surgery was 62.8, 32.6% and 10.9%, respectively, with a median intrahepatic recurrence-free survival time of 13.47 months. Moderately differentiated tumours (HR 0.259, 95% CI 0.078-0.857, p = 0.027) and the development of liver metastasis more than 2 years after breast surgery (HR 0.270, 95% CI 0.108-0.675, p = 0.005) might be predictors of increased IHRFS. Conclusions An interval of more than 2 years between breast cancer surgery and liver metastasis seems to be an indication of liver surgery in BCLM patients. The Pringle manoeuvre and moderately differentiated tumours are potential predictors associated with OS and IHRFS, respectively, as benefits from liver resection. Studies with increased sample sizes are warranted to validate our results.

Local Treatment of Breast Cancer Liver Metastasis

“…In contrast to the substantial evidence for local treatment of colorectal liver metastases, the data for resection of BCLM are limited. In heterogenous case series the reported median 3-, and 5-year survival rates after metastasectomy of BCLM range between 24–116 months, and 49–94% and 5–78%, respectively [3,10,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42]. In a systematic review Fairhurst et al [55] analyzed 33 papers dealing with resection of BCLM in a total of 956 patients.…”

“…Moreover, response to preoperative systemic therapy has been identified as a prognostic factor which is likely related to effective systemic eradication of microscopic metastatic lesions [3,21,30]. In addition, complete macroscopic and microscopic resection (R0) [3,29,30,32,40], liver-limited disease (with the exception of isolated pulmonary and bony metastases) [23,39,59], solitary BCLM [36,41], a long interval (more than 1 year) between breast cancer diagnosis and the detection of BCLM [21,28,29,35,37,57] and patients with PgR- and/or ER-positive BCLM [21,22,23,27,30,34,60] were independent prognostic factors. In conclusion at least a selected group of patients with BCLM benefits from aggressive local curative treatment.…”

Risk and prognostic factors of breast cancer with liver metastases

“…A recent study reported the rst discovery of the functional role of the DNA of neutrophil extracellular traps (NETs) in promoting breast cancer liver metastasis, a mechanism distinct from previous studies on cytokines and chemokine receptors, integrin complexes, metabolic program and proliferation signaling [27,28]. Early detection of liver metastases seemed to confer better outcomes of speci c patients due to more effective treatments and better tolerance [29][30][31][32][33][34]. However, guidelines have reiterated that routine laboratory and imaging examination may not be applicable for patients with early breast cancer in the absence of signs or symptoms of metastatic disease because these examinations may not bring more survival bene ts [35][36][37].…”

Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review

“…Hepatic resection is the most published intervention for management of BCLM (Table 2). Of 23 studies, 13 provided mean diameter of liver metastasis (8,9,14,19,21,(24)(25)(26)(29)(30)(31)(32). The median tumor size was 3 cm (1.8-5.2 cm).…”

“…Her2 positive tumors totaled 117 patients. Nineteen studies reported mean time between diagnosis of primary of liver metastasis (8,9,13,(15)(16)(17)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Six studies provided details of receptor status at time of hepatectomy (16,17,20,25,28,30).…”