Resection of liver metastases from breast cancer: Estrogen receptor status and response to chemotherapy before metastasectomy define outcome

• Published in: Surgery 2012-05, Vol.151 (5), p.710-716
• Main Authors: Abbott, Daniel E., MD, Brouquet, Antoine, MD, Mittendorf, Elizabeth A., MD, Andreou, Andreas, MD, Meric-Bernstam, Funda, MD, Valero, Vicente, MD, Green, Marjorie C., MD, Kuerer, Henry M., MD, PhD, Curley, Steven A., MD, Abdalla, Eddie K., MD, Hunt, Kelly K., MD, Vauthey, Jean-Nicolas, MD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biomarkers, Tumor - metabolism; Breast Neoplasms - metabolism; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Carcinoma, Ductal, Breast - metabolism; Carcinoma, Ductal, Breast - mortality; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - therapy; Carcinoma, Lobular - metabolism; Carcinoma, Lobular - mortality; Carcinoma, Lobular - pathology; Carcinoma, Lobular - therapy; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gynecology. Andrology. Obstetrics; Hepatectomy; Humans; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Mammary gland diseases; Mastectomy; Medical sciences; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Receptors, Estrogen - metabolism; Receptors, Progesterone - metabolism; Retrospective Studies; Surgery; Survival Analysis; Treatment Outcome; Tumors
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2011.12.017

Background The oncologic benefit of resecting liver metastases in patients with breast cancer is unclear. This study was performed to identify predictors of survival after hepatectomy. 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. Results 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. Conclusion 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.