The role of liver resection in patients with metastatic breast cancer: a systematic review examining the survival impact

Tasleem, Sadia; Bolger, Jarlath; Kelly, Michael E.; Boland, Michael R.; Bowden, Dermot; Sweeney, Karl; Malone, Carmel

doi:10.1007/s11845-018-1746-9

Cited by 21 publications

(17 citation statements)

References 64 publications

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“…Apart from the detection of recurrence, other advantages of this approach include the low cost of tumour marker testing and the decrease in radiation burden incurred by patients when radiodiagnostic methods such as CT or PET CT alone are used to diagnose recurrence. Tumour markers are also important indicators of the efficacy of oncological treatment of this disease (23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Třeška¹,

Topolčan²,

Zoubkova³

et al. 2018

Anticancer Res

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Abstract. Background RFS (p<0.04; p<0.01; p<0.02), while CA19-9 postoperative levels were significant for OS and RFS (p<0.03; p<0.01 Breast cancer (BC) represents the most frequent cancer worldwide among women and is one of the most frequent causes of death in this population. BC metastases either develop concomitantly with the primary BC or at different time intervals in more than 50% of women with BC. Breast cancer liver metastases (BCLM) in most women are associated with concurrent BC dissemination to the lungs and bones and these represent the only site of metastatic BC in 12-15% women. Although great progress has been made in the diagnosis and effective treatment of BC, metastases develop in 30% of women despite timely diagnosis and radical treatment (1, 2).Surgical treatment of BCLM is an important component of multimodal therapeutic approaches. However, its results remain suboptimal compared, for example, to patients with colorectal cancer liver metastases. In our view, one strategy that might improve the results of surgical management of BCLM is the search for early indicators of tumour dissemination or for prognostically high-risk patients.Tumour markers are general indicators used in monitoring and follow-up of patients. The most frequently used markers to monitor treatment efficacy and diagnose BCLM recurrence include mucins, such as carbohydrate antigen CA 19-9, cytokeratins such as tissue polypeptide antigen (TPA) and tissue-specific polypeptide antigen (TPS), proliferation markers such as thymidine kinase (TK) and carcinoembryonic antigen (CEA). However, no study regarding the prognostic significance of preoperative serum tumour marker levels in patients undergoing surgery for BCLM has been published to date, as far as we are aware.The aim of our retrospective study was to determine whether perioperative levels of clinically routinely used tumour markers influence overall survival (OS) and recurrence-free survival (RFS) of patients undergoing resection or thermoablative therapy for BCLM as part of a multimodal approach. Patients and MethodsFrom January 1, 2000 until January 1, 2018, a total of 32 women underwent surgery for BCLM at the Department of Surgery, University Hospital in Pilsen, Czech Republic. Surgery was indicated in women in a general good state of health from the aspect of surgery and those who had consented to undergo the proposed surgical procedure. Surgery was indicated only if the metastases were located solely within the liver parenchyma. Every patient underwent hybrid imaging using positron-emission tomography (PET) and computed tomography (CT) or PET and magnetic resonance imaging (MRI) before surgery. Another requirement was that the future liver remnant volume exceed 30% of the total liver volume. The average age of these women was 49.5±10.7 years. The primary BC types were: ductal in 20 cases, lobular in seven, erysipeloid in four, and sarcomatoid (spindle cell) carcinoma in one. The average interval between initial breast surgery and BCLM surgery was 4.7±3.7 years.

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Section: Discussionmentioning

confidence: 99%

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Třeška¹,

Topolčan²,

Zoubkova³

et al. 2018

Anticancer Res

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“…This strategy has been designated as "adjuvant surgical debulking" when LMBC are resected by means hepatectomy after systemic therapy. [1][2][3][4][5][6] Nowadaysthis approach has been widespread in oncological scenario around the world. However, many questions still need to be answered, for example: How should we choose or even select the patients whocan present a true benefit with an aggressive surgical treatment of LMBC?…”

Section: Discussionmentioning

confidence: 99%

“…The more important PG for LMBC that have been described in the literature are: both number and diameter of lesions, extra-hepatic disease, disease-free survival time between primary lesion treatment and development of liver metastasis, preoperative chemotherapy, response to chemotherapy, microscopic margins,microscopic vascular or lymphatic invasion, hormone receptors (ER and PgR) andmore recently receptor of HER2. [1][2][3][4][5][6][7][8] These PG have been shown as significant to attain a longterm survival. [1][2][3][4][5][6][7][8] Currently, new biological prognostic factors have been largely studied in relation to BC, especially those designated as biomarkers.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, HR for LMBC has been considered anapproach reasonable for very selected situations. [1][2][3][4][5][6][7][8] Recently, "first-liver approach" or reverse surgery has been extensively studied for treatment of synchronous liver metastasis of colorectal cancer (LMCRC). Long-term results may be similar to those observed when is performed the classical approach.…”

Section: Introductionmentioning

confidence: 99%

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Reverse surgery (“first-liver approach”) for hepatic metastases from breast cancer

Costa¹,

Botan²,

Araujo³

et al. 2018

GHOA

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Background: Hepatic resection for liver metastasis from breast cancer (LMBC) canattain long-term survival. Since BC has been a very sensitive neoplasm to chemotherapy, surgical resection of residual LMBC has presented an important role associated withsystemic therapy. Reverse approach ("first liver approach") has been performed for liver metastasis from colorectal cancer (LMCRC), mainly for multiple synchronic metastases that have presented partial response. Case report: We report a case of LMBC in young female who has undergone successful"first liver approach" after partial response tosystemic therapy. At first, it was performed open right hepatectomy with caudate lobectomy and atypical resection of three small lesions in left lobe. After two postoperative cycles of chemotherapy associated a target therapy, she has finally submitted a radical mastectomy and selective axillary lymphadenectomy. To date, thirty months after hepatic resection, she is alive without any recurrence.

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confidence: 99%

A positive conversion in hormone receptor and HER2 status might have an impact on survival after liver resection for breast cancer metastases

Altundağ

2018

Ir J Med Sci

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To the Editor, I wish to congratulate Tasleem and their colleagues for their article [1] in which they reviewed the evidence for resection of breast cancer-related liver metastases. Hepatic resection can be considered in the management of breast cancer patients with isolated liver metastases as well as those with oligometastatic disease. However, authors did not much give detailed information about variation in hormone receptor and HER-2 status between primary and metastatic breast cancer. A change of estrogen receptor (ER), progesterone receptor (PR), and HER2 status in distant metastases has frequently been reported. The actual incidence of this phenomenon has been debated. Recent meta-analysis including 39 studies assessing receptor conversion from primary breast tumors to paired distant breast cancer metastases showed that negative to positive conversion percentages were 21.5, 15.9, and 9.5% for ER, PR, and HER2. Furthermore, PR discordance was higher in bone and liver metastases compared with central nervous system metastases [2]. However, the impact of receptor conversion on treatment efficacy and survival is not known yet in metastatic breast cancer and needs to be determined in prospective studies. Assessing hormone receptor status and HER2 status in metastatic sites is strongly recommended.

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The role of liver resection in patients with metastatic breast cancer: a systematic review examining the survival impact

Abstract: Hepatic resection can be considered in the management of breast cancer patients with isolated liver metastases as well as those with oligometastatic disease.

Cited by 21 publications

References 64 publications

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Reverse surgery (“first-liver approach”) for hepatic metastases from breast cancer

A positive conversion in hormone receptor and HER2 status might have an impact on survival after liver resection for breast cancer metastases

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