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Resection of liver metastases from breast cancer: Estrogen receptor status and response to chemotherapy before metastasectomy define outcome
Surgery, 02/03/2012
Abbott DE et al. – Resection of breast cancer liver metastases in patients with estrogen receptor–positive disease that is responding to chemotherapy is associated with improved survival. The timing of operative intervention may be critical; resection before progression is associated with a better outcome.
Methods- Between 1997 and 2010, 86 patients underwent resection of breast cancer liver metastases.
- Clinicopathologic characteristics of the primary breast neoplasm, timing of metastasis development, and treatment were recorded.
- Response to prehepatectomy chemotherapy was evaluated according to Response Criteria in Solid Tumors criteria, and the best response to chemotherapy during treatment and the response immediately before hepatectomy were noted.
- Univariate and multivariate analyses were performed to identify predictors of disease–free survival and overall survival.
- Fifty–nine patients (69%) had estrogen receptor– or progesterone receptor– positive primary breast neoplasms.
- Fifty–three patients (62%) had a solitary breast cancer liver metastasis, and 73 (85%) had breast cancer liver metastases ≤5 cm.
- Sixty–five patients (76%) received prehepatectomy hormonal and/or chemotherapy.
- Four patients (6%) had progressive disease as the best response, and 19 patients (30%) had progressive disease before hepatectomy (P < .001).
- Seventy percent of patients who received preoperative chemotherapy or hormonal therapy had either response or stable disease immediately before hepatectomy. No postoperative deaths were observed.
- At a 62–month median follow–up, the disease–free survival and overall survival were 14 and 57 months, respectively.
- On univariate analysis, estrogen receptor/progesterone receptor status of the primary breast neoplasm, best radiographic response, and preoperative radiographic response were associated with overall survival.
- On multivariate analysis, estrogen receptor–negative primary breast disease (P = .009; hazard ratio, 3.3; 95% confidence interval, 1.4–8.2) and preoperative progressive disease (P = .003; hazard ratio, 3.8; 95% confidence interval, 1.6–9.2) were associated with decreased overall survival.