The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: a multi-institutional analysis

• Published in: HPB (Oxford, England) Vol. 18; no. 8; pp. 700 - 705
• Main Authors: Margonis, Georgios A, Buettner, Stefan, Sasaki, Kazunari, Kim, Yuhree, Ratti, Francesca, Russolillo, Nadia, Ferrero, Alessandro, Berger, Nickolas, Gamblin, T. Clark, Poultsides, George, Tran, Thuy, Postlewait, Lauren M, Maithel, Shishir, Michaels, Alex D, Bauer, Todd W, Marques, Hugo, Barroso, Eduardo, Aldrighetti, Luca, Pawlik, Timothy M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2016; Elsevier
• Subjects: Aged; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Databases, Factual; Female; Gastroenterology and Hepatology; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Italy; Kaplan-Meier Estimate; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Margins of Excision; Metastasectomy - adverse effects; Metastasectomy - methods; Metastasectomy - mortality; Middle Aged; Multivariate Analysis; Original; Portugal; Proportional Hazards Models; Risk Factors; Time Factors; Treatment Outcome; Tumor Burden; United States
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2016.05.014

Abstract Background Data on surgical management of breast liver metastasis are limited. We sought to determine the safety and long-term outcome of patients undergoing hepatic resection of breast cancer liver metastases (BCLM). Methods Using a multi-institutional, international database, 131 patients who underwent surgery for BCLM between 1980 and 2014 were identified. Clinicopathologic and outcome data were collected and analyzed. Results Median tumor size of the primary breast cancer was 2.5 cm (IQR: 2.0–3.2); 58 (59.8%) patients had primary tumor nodal metastasis. The median time from diagnosis of breast cancer to metastasectomy was 34 months (IQR: 16.8–61.3). The mean size of the largest liver lesion was 3.0 cm (2.0–5.0); half of patients (52.0%) had a solitary metastasis. An R0 resection was achieved in most cases (90.8%). Postoperative morbidity and mortality were 22.8% and 0%, respectively. Median and 3-year overall-survival was 53.4 months and 75.2%, respectively. On multivariable analysis, positive surgical margin (HR 3.57, 95% CI 1.40–9.16; p = 0.008) and diameter of the BCLM (HR 1.03, 95% CI 1.01–1.06; p = 0.002) remained associated with worse OS. Discussion In selected patients, resection of breast cancer liver metastases can be done safely and a subset of patients may derive a relatively long survival, especially from a margin negative resection.