Evolving Role of Liver Resection in Selected Patients With Metastatic Breast Cancer.
Chemotherapy; Hepatectomy; Metastasectomy; Overall survival; Stage 4 breast cancer
Neoplasms | Oncology | Surgery | Surgical Procedures, Operative
BACKGROUND: More effective chemotherapy regimens combined with metastasectomy have improved overall survival (OS) in several cancer populations. The value of liver resection (LR) in breast cancer liver metastasis (BCLM) remains controversial. We sought to investigate the role of LR in BCLM as a therapeutic option in patients with isolated liver metastasis.
METHODS: The National Cancer Data Base (NCDB) was queried for patients with BCLM diagnosed from 2010 to 2014. The primary outcome was the OS. Kaplan-Meier and Cox proportional hazards regression were performed for intergroup comparison.
RESULTS: A total of 9244 patients with BCLM were included. The median age was 58 y (IQR 49-68 y). Of them, 2632 (28.5%) patients had isolated liver metastasis, 1957 (78.2%) received chemotherapy, 93 (3.6%) underwent LR, and only 83 (3.2%) received chemotherapy and LR. Median OS for the entire cohort and for patients with isolated BCLM was 18.3 mo and 29 mo, respectively. Chemotherapy with LR was associated with superior OS compared to chemotherapy alone (69.7 versus 49.2 mo, P < 0.001) in patients with BCLM: ER+ (69.6 versus 54.1 mo, P = 0.002) and triple-negative BC (49.2 versus 17.6 mo, P = 0.006). Cox regression showed that LR, chemotherapy, and positive hormone receptor status (ER+, PR+, and/or HER2+) were independent predictors of improved OS. Advanced age and comorbidity score negatively impacted OS.
CONCLUSIONS: This is the largest series thus far assessing the role of LR in patients with BCLM. LR plus chemotherapy may be associated with acceptable outcomes in selected patients with BCLM. LR should be considered in patients with isolated BCLM who had a good response to systemic therapy.
Publisher or Conference
Journal of Surgical Research
Millen JA, Hofmann A, Mesquita-Neto JW, Rose J, Macedo FI. Evolving Role of Liver Resection in Selected Patients With Metastatic Breast Cancer [published online ahead of print, 2020 Nov 11]. J Surg Res. 2020;S0022-4804(20)30685-5. https://doi.org/10.1016/j.jss.2020.09.022