Yun Shin Chun1, Takashi Mizuno2, Jordan M Cloyd3, Min Jin Ha4, Kiyohiko Omichi2, Ching-Wei D Tzeng2, Thomas A Aloia2, Naoto T Ueno5, Henry M Kuerer6, Carlos H Barcenas5, Jean-Nicolas Vauthey2. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: yschun@mdanderson.org. 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Surgery, Ohio State University, Columbus, OH, USA. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abstract
INTRODUCTION: The role of surgery for breast cancer liver metastases (BCLM) remains controversial. This study aimed to analyze survival in patients treated with hepatectomy plus systemic therapy or systemic therapy alone for BCLM and to determine selection factors to guide surgical therapy. MATERIALS AND METHODS: Patients who underwent hepatectomy plus systemic therapy (n = 136) and systemic therapy alone for isolated BCLM (n = 763) were compared. Overall survival (OS) was analyzed after propensity score matching. Intrinsic subtypes were defined as: luminal A (estrogen receptor [ER]+ and/or progesterone receptor positive [PR]+, human epidermal growth factor receptor 2 [HER2]-), luminal B (ER and/or PR+, HER2+), HER2-enriched (ER and PR-, HER2+), and basal-like (ER, PR, HER2-). RESULTS: After hepatectomy, independent predictors of poor OS were number and size of liver metastases, and intrinsic subtype (hazard ratios, 1.11, 1.16, and 4.28, respectively). Median OS was 75 and 81 months among patients with luminal B and HER2-enriched subtypes, compared with 17 and 53 months among patients with basal-like and luminal A subtypes (P < .001). Median progression-free survival (PFS) was 60 months with the HER2-enriched subtype, compared with 17, 16, and 5 months with luminal A, luminal B, and basal-like subtypes, respectively (P < .001). After propensity score matching, 5-year OS rates were 56% vs. 40% in the surgery vs. systemic therapy alone groups (P = .018). CONCLUSION: Surgical resection of BCLM yielded higher OS compared with systemic therapy alone and prolonged PFS among patients with the HER2-enriched subtype. These findings support the use of surgical therapy in appropriately selected patients, based on intrinsic subtypes.
INTRODUCTION: The role of surgery for breast cancer liver metastases (BCLM) remains controversial. This study aimed to analyze survival in patients treated with hepatectomy plus systemic therapy or systemic therapy alone for BCLM and to determine selection factors to guide surgical therapy. MATERIALS AND METHODS:Patients who underwent hepatectomy plus systemic therapy (n = 136) and systemic therapy alone for isolated BCLM (n = 763) were compared. Overall survival (OS) was analyzed after propensity score matching. Intrinsic subtypes were defined as: luminal A (estrogen receptor [ER]+ and/or progesterone receptor positive [PR]+, humanepidermal growth factor receptor 2 [HER2]-), luminal B (ER and/or PR+, HER2+), HER2-enriched (ER and PR-, HER2+), and basal-like (ER, PR, HER2-). RESULTS: After hepatectomy, independent predictors of poor OS were number and size of liver metastases, and intrinsic subtype (hazard ratios, 1.11, 1.16, and 4.28, respectively). Median OS was 75 and 81 months among patients with luminal B and HER2-enriched subtypes, compared with 17 and 53 months among patients with basal-like and luminal A subtypes (P < .001). Median progression-free survival (PFS) was 60 months with the HER2-enriched subtype, compared with 17, 16, and 5 months with luminal A, luminal B, and basal-like subtypes, respectively (P < .001). After propensity score matching, 5-year OS rates were 56% vs. 40% in the surgery vs. systemic therapy alone groups (P = .018). CONCLUSION: Surgical resection of BCLM yielded higher OS compared with systemic therapy alone and prolonged PFS among patients with the HER2-enriched subtype. These findings support the use of surgical therapy in appropriately selected patients, based on intrinsic subtypes.
Authors: Georgios A Margonis; Stefan Buettner; Kazunari Sasaki; Yuhree Kim; Francesca Ratti; Nadia Russolillo; Alessandro Ferrero; Nickolas Berger; T Clark Gamblin; George Poultsides; Thuy Tran; Lauren M Postlewait; Shishir Maithel; Alex D Michaels; Todd W Bauer; Hugo Marques; Eduardo Barroso; Luca Aldrighetti; Timothy M Pawlik Journal: HPB (Oxford) Date: 2016-06-29 Impact factor: 3.647
Authors: Debora Fumagalli; Philippe L Bedard; Zeina Nahleh; Stefan Michiels; Christos Sotiriou; Sherene Loi; Joseph A Sparano; Matthew Ellis; Nola Hylton; Jo Anne Zujewski; Clifford Hudis; Laura Esserman; Martine Piccart Journal: Lancet Oncol Date: 2012-06 Impact factor: 41.316
Authors: Antonio Llombart-Cussac; Javier Cortés; Laia Paré; Patricia Galván; Begoña Bermejo; Noelia Martínez; Maria Vidal; Sònia Pernas; Rafael López; Montserrat Muñoz; Paolo Nuciforo; Serafín Morales; Mafalda Oliveira; Lorena de la Peña; Alexandra Peláez; Aleix Prat Journal: Lancet Oncol Date: 2017-02-24 Impact factor: 41.316
Authors: E A Eisenhauer; P Therasse; J Bogaerts; L H Schwartz; D Sargent; R Ford; J Dancey; S Arbuck; S Gwyther; M Mooney; L Rubinstein; L Shankar; L Dodd; R Kaplan; D Lacombe; J Verweij Journal: Eur J Cancer Date: 2009-01 Impact factor: 9.162
Authors: Maurizio Cardi; Marc Pocard; Rea Lo Dico; Gianmaria Fiorentini; Mario Valle; Roberta Gelmini; Marco Vaira; Enrico Maria Pasqual; Salvatore Asero; Gianluca Baiocchi; Andrea Di Giorgio; Alessandra Spagnoli; Francesco Di Marzo; Bianca Sollazzo; Giuseppe D'Ermo; Daniele Biacchi; Franco Iafrate; Paolo Sammartino Journal: Front Oncol Date: 2022-05-11 Impact factor: 5.738
Authors: Caitlin E Marks; Samantha M Thomas; Oluwadamilola M Fayanju; Gayle DiLalla; Sarah Sammons; E Shelley Hwang; Jennifer K Plichta Journal: Am J Surg Date: 2021-07-22 Impact factor: 2.565