J Breast Cancer.  2013 Jun;16(2):184-192. 10.4048/jbc.2013.16.2.184.

Prognostic Factors Related to Surgical Outcome of Liver Metastases of Breast Cancer

• Kostov DV
• Kobakov GL
• Yankov DV

• KMID: 2286399
• DOI: http://doi.org/10.4048/jbc.2013.16.2.184

Abstract

PURPOSE
The role of hepatectomy for patients with liver metastases of breast cancer (LMBC) remains controversial. The purpose of this study is to share our experience with hepatic resection in a relatively unselected group of patients with LMBC and analyse the prognostic factors and indications for surgery.
METHODS
In 2000 to 2006, 42 female patients with a mean age of 58.2 years (range, 39 to 69 years) with LMBC diagnosed by means of abdominal ultrasound, computed tomography and/or magnetic resonance imaging in the hospital. They were considered for surgery because of limited comorbidities, presence of seven or fewer liver tumors and absence of (or limited and stable) extrahepatic disease on preoperative imaging. Patients' demographics, metastatic characteristics as well as clinical and operative parameters were being studied. Overall actuarial 1-, 3-, and 5-year survival rates were calculated since the hepatic resection onwards using the Kaplan-Meier method.
RESULTS
Metastatic tumor size of < or =4 cm (p=0.03), R0 resection (p=0.02), negative portal lymph nodes (p=0.01), response to chemotherapy (p=0.02), and positive hormone receptor status (p=0.03) were associated with better survival outcomes on univariate analysis. However, it did not show survival benefits on multivariate analysis. The disease-free survival and overall survival are 29.40 and 43 months, respectively. The 1-, 3- and 5-year survival rates were 84.61%, 64.11%, and 38.45%, respectively.
CONCLUSION
Selected patients with isolated LMBC may benefit from surgical management; although, indications remain unclear and the risks may outweigh the benefits in patients with a generally poor prognosis. Improvements in preoperative staging and progressive application of new multimodality treatments will be the key to improved survival rates in this severe disease. The careful selection of patients is associated with a satisfactory long-term survival rate.

Keyword

Breast neoplasms; Hepatectomy; Neoplasm metastasis

MeSH Terms

Breast
Breast Neoplasms
Comorbidity
Demography
Disease-Free Survival
Female
Hepatectomy
Humans
Liver
Lymph Nodes
Magnetic Resonance Imaging
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Survival Rate

Figure

• 

  Figure 1 Survival curves according to tumor characteristics. (A) Overall survival curve for patients who underwent a hepatectomy for liver metastases of breast cancer (LMBC) calculated since surgery onwards (p=0.03). (B) Cumulative survival curves compare metastasis size of ≤4 cm and >4 cm (p=0.03). (C) Cumulative survival curves compare R0 and R1 resections (p=0.02). (D) Cumulative survival curves compare chemotherapy responders and nonresponders (p=0.02). (E) Cumulative survival curves compare positive and negative hormone receptor status (p=0.03). (F) Cumulative survival curves compare negative and positive portal lymph nodes (p=0.01).

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