Liver metastases from breast cancer: Long-term survival after curative resection☆ (original) (raw)

Abstract

SURGERY 383 LIVER METASTASES develop in approximately half of all women with metastatic breast cancer and are typically associated with tumor deposits at other sites, indicating advanced disease and poor outcome. However, in a small proportion of patients with breast cancer (1%), focal liver metastasis is the only sign of dissemination of the disease. 1,2 The natural history of this condition is poorly defined, and the management remains controversial. Although most physicians view liver metastases from breast cancer with resignation or attempt palliation with hormones and chemotherapy, some groups have advocated aggressive approaches, including liver resection. The number of reported series has remained small and heterogeneous and, with only a few cases in each series, interpretation of the results is difficult. Liver resection offers the only chance of cure in patients with a variety of primary and secondary liver tumors; for example, 25% to 38% of patients with hepatic colorectal metastases are cured by surgery in the absence of extrahepatic disease. On this basis, a decade ago we opted for an aggressive policy, including hepatectomy, for women in whom liver metastases from breast cancer were the only manifestations of dissemination. Here we report the results in 17 consecutive women with resectable liver metastases from breast cancer seen Liver metastases from breast cancer: Long-term survival after curative resection Background. Liver metastases from breast cancer are associated with a poor prognosis (median survival <6 months). A subgroup of these patients with no dissemination in other organs may benefit from surgery. Available data in the literature suggest that only in exceptional cases do these patients survive more than 2 years when given chemohormonal therapy or supportive care alone. We report the results of liver resection in patients with isolated hepatic metastases from breast cancer and evaluate the rate of long-term survival, prognostic factors, and the role of neoadjuvant high-dose chemotherapy. Patients and methods. Over the past decade, 17 women underwent hepatic metastectomy with curative intent for metastatic breast cancer. The follow-up was complete in each patient. The median age at the time breast cancer was diagnosed was 48 years. Neoadjuvant high-dose chemotherapy (HDC) with hematopoietic progenitor support was used in 10 patients before liver resection. Perioperative complications, long-term outcome, and prognostic factors were evaluated. Results. Seven of the 17 patients are currently alive, with follow-up of up to 12 years. Four of these patients are free of tumors after 6 and 17 months and 6 and 12 years. The actuarial 5-year survival rate is 22%. One patient died postoperatively (mortality rate, 6%) of carmustine-induced fibrosing pneumonitis. There was no further major morbidity in the other patients. The liver was the primary site of recurrent disease after liver resection in 67% of the patients. Patients in whom liver metastases were found more than 1 year after resection of the primary breast cancer had a significantly better outcome than those with early (<1 year) metastatic disease (P = .04). The type of liver resection, the lymph node status at the time of the primary breast cancer resection, and HDC had no significant impact on patient survival in this series. Conclusions. Favorable 22% long-term survival can be achieved with metastasectomy in this selected group of patients. Careful evaluation of pulmonary toxicity from carmustine and exclusion of patients with extrahepatic disease are critical. Improved survival might be achieved with better selection of patients and the use of liver-directed adjuvant therapy.

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