Janelle-Cheri A Millen1, Alana Hofmann1, Jose Wilson Mesquita-Neto2, Jeffrey Rose3, Francis I Macedo4. 1. The Department of Surgery, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, Florida. 2. The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan. 3. The Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, Florida. 4. The Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, Florida. Electronic address: igmacedo1@gmail.com.
Abstract
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.
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.
Authors: Richard Wu; Keerthi Gogineni; Jane Meisel; Stephen Szabo; Meenakshi Thirunavu; Sarah Friend; Zachary Bercu; Ila Sethi; Neela Natarajan; Jeffrey Switchenko; Jason Levy; Eddie Abdalla; Laura Weakland; Kevin Kalinsky; Nima Kokabi Journal: Cardiovasc Intervent Radiol Date: 2022-08-25 Impact factor: 2.797