Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St. George Hospital, Sydney, Australia.
Eur J Cancer. 2011 Oct;47(15):2282-90. doi: 10.1016/j.ejca.2011.06.024. Epub 2011 Jul 7.
Systemic chemotherapy is the mainstay of treatment for metastatic breast cancer with the role of surgery being strictly limited for palliation of metastatic complications or locoregional relapse. An increasing number of studies examining the role of therapeutic hepatic metastasectomy show encouraging survival results. A systematic review was undertaken to define its safety, efficacy and to identify prognostic factors associated with survival.
Electronic search of the MEDLINE and PubMed databases (January 2000-January 2011) to identify studies reporting outcomes of hepatectomy for breast cancer liver metastases (BCLM) with hepatectomy was undertaken. Two reviewers independently appraised each study using a predetermined protocol. Safety and clinical efficacy was synthesised through a narrative review with full tabulation of results of all included studies.
Nineteen studies were examined. This comprised of 553 patients. Hepatectomy for BCLM was performed at a rate of 1.8 (range, 0.7-7.7) cases per year in reported series. The median time to liver metastases occurred at a median of 40 (range, 23-77) months. The median mortality and complication rate were 0% (range, 0-6%) and 21% (range, 0-44%), respectively. The median overall survival was 40 (range, 15-74) months and median 5-year survival rate was 40% (range, 21-80%). Potential prognostic factors associated with a poorer overall survival include a positive liver surgical margin and hormone refractory disease.
Hepatectomy is rarely performed for BCLM but the studies described in this review indicate consistent results with superior 5-year survival for selected patients with isolated liver metastases and in those with well controlled minimal extrahepatic disease. To evaluate its efficacy and control for selection bias, a randomised trial of standard chemotherapy with or without hepatectomy for BCLM is warranted.
全身化疗是转移性乳腺癌的主要治疗方法，手术的作用严格限于缓解转移性并发症或局部复发。越来越多的研究探讨了治疗性肝转移切除术的作用，显示出令人鼓舞的生存结果。进行了系统评价，以确定其安全性、疗效，并确定与生存相关的预后因素。
电子检索 MEDLINE 和 PubMed 数据库（2000 年 1 月至 2011 年 1 月），以确定报道乳腺癌肝转移（BCLM）肝切除术结果的研究。两名审查员使用预定的方案独立评估每项研究。通过叙述性综述综合安全性和临床疗效，并详细列出所有纳入研究的结果。
检查了 19 项研究。这包括 553 名患者。在报道的系列中，BCLM 的肝切除术每年进行 1.8 例（范围，0.7-7.7）。肝转移的中位时间为 40 个月（范围，23-77）。中位死亡率和并发症发生率分别为 0%（范围，0-6%）和 21%（范围，0-44%）。中位总生存时间为 40 个月（范围，15-74），中位 5 年生存率为 40%（范围，21-80%）。与总体生存较差相关的潜在预后因素包括肝手术切缘阳性和激素难治性疾病。
肝切除术很少用于 BCLM，但本综述中描述的研究表明，对于孤立性肝转移和具有良好控制的微小肝外疾病的选定患者，具有一致的结果，5 年生存率更高。为了评估其疗效并控制选择偏倚，有必要对 BCLM 的标准化疗加或不加肝切除术进行随机试验。
