Rodes Brown S, Martin R C G
Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Minerva Chir. 2012 Aug;67(4):297-308.
Systemic hormonal and cytotoxic chemotherapy still remains the optimal treatment for metastatic breast cancer with the role of surgery being strictly limited for palliation of metastatic complications or locoregional relapse. However there has been a greater awareness of liver dominant and liver only metastatic disease that remains more refractory to systemic chemotherapy alone. A systematic review was undertaken to define its safety, efficacy and to identify prognostic factors associated with liver only or liver dominant metastatic breast cancer.
Electronic search of the MEDLINE, PubMed and Scopus databases (January 2000-January 2012) to identify studies reporting outcomes for liver dominant breast cancer metastasis. Two reviewers independently appraised each study using a predetermined protocol. Safety and clinical efficacy was synthesized through a narrative review with full tabulation of results of all included studies.
A total of 61 studies were identified that reported liver dominant metastatic breast cancer and comprised a total of 8260 patients. Chemotherapy alone was reported in 27 studies involving 4958 patients with a median overall survival of 17.9 months (range 6 to 29.2). Surgical resection of liver metastasis was reported in 24 studies involving 2552 patients with a median overall survival of 38.1 months (range 10.9 to 57). Hepatic arterial therapy was reported in six studies involving 373 patients with a median overall survival of 27.9 months (range 18.5 to 47).
Liver dominant or liver only metastatic breast cancer is a common presentation and clinical problem in a subset of patients. Consideration of hepatic resection, ablation or hepatic arterial therapy should be considered, but are still rarely performed. Continued review and identification of liver only-liver dominant is needed to ensure this subset of patients with metastatic breast cancer can achieve optimal improvement in quality of life time.
全身激素治疗和细胞毒性化疗仍然是转移性乳腺癌的最佳治疗方法，手术的作用严格限于缓解转移性并发症或局部区域复发。然而，人们越来越认识到以肝脏为主和仅肝脏转移的疾病对单纯全身化疗更具难治性。进行了一项系统评价，以确定其安全性、疗效，并确定与仅肝脏或以肝脏为主的转移性乳腺癌相关的预后因素。
对MEDLINE、PubMed和Scopus数据库进行电子检索（2000年1月至2012年1月），以识别报告以肝脏为主的乳腺癌转移结果的研究。两名评审员使用预先确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，并完整列出所有纳入研究的结果。
共确定了61项报告以肝脏为主的转移性乳腺癌的研究，共纳入8260例患者。27项研究报告了单纯化疗，涉及4958例患者，中位总生存期为17.9个月（范围6至29.2个月）。24项研究报告了肝转移瘤的手术切除，涉及2552例患者，中位总生存期为38.1个月（范围10.9至57个月）。6项研究报告了肝动脉治疗，涉及373例患者，中位总生存期为27.9个月（范围18.5至47个月）。
以肝脏为主或仅肝脏转移的乳腺癌在一部分患者中是常见的表现和临床问题。应考虑肝切除、消融或肝动脉治疗，但仍很少实施。需要持续审查和识别仅肝脏或以肝脏为主的情况，以确保这部分转移性乳腺癌患者能够在生活质量和生存时间方面实现最佳改善。
