Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4095, USA.
Surgery. 2012 May;151(5):710-6. doi: 10.1016/j.surg.2011.12.017. Epub 2012 Jan 29.
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.
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.
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.
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.
在乳腺癌患者中，切除肝转移灶的肿瘤学获益尚不清楚。本研究旨在确定肝切除术后生存的预测因素。
1997 年至 2010 年间，86 例患者接受了乳腺癌肝转移切除术。记录了原发性乳腺癌的临床病理特征、转移发展时间和治疗情况。根据实体瘤反应评价标准评估术前化疗的反应，并记录治疗过程中及肝切除术前的最佳化疗反应。进行单因素和多因素分析以确定无病生存和总生存的预测因素。
59 例（69%）患者的原发性乳腺癌有雌激素受体或孕激素受体阳性。53 例（62%）患者有单发乳腺癌肝转移，73 例（85%）患者的乳腺癌肝转移灶直径≤5cm。65 例（76%）患者接受了术前激素和/或化疗。4 例（6%）患者的最佳反应为疾病进展，19 例（30%）患者在肝切除术前出现疾病进展（P<0.001）。70%接受术前化疗或激素治疗的患者在肝切除术前的反应或疾病稳定。术后无死亡病例。中位随访 62 个月时，无病生存率和总生存率分别为 14 个月和 57 个月。单因素分析显示，原发性乳腺癌的雌激素受体/孕激素受体状态、最佳影像学反应和术前影像学反应与总生存率相关。多因素分析显示，雌激素受体阴性的原发性乳腺癌疾病（P=0.009；风险比，3.3；95%置信区间，1.4-8.2）和术前疾病进展（P=0.003；风险比，3.8；95%置信区间，1.6-9.2）与总生存率降低相关。
对于正在接受化疗且有反应的雌激素受体阳性疾病的乳腺癌肝转移患者，切除可改善生存。手术干预的时机可能很关键；在进展前进行切除与更好的结果相关。
