Division of Colon & Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan.
Division of General Surgery, E-Da Da-Chang Hospital, Kaohsiung, Taiwan.
PLoS One. 2022 Apr 21;17(4):e0266960. doi: 10.1371/journal.pone.0266960. eCollection 2022.
Liver metastases from breast cancer are associated with poor prognosis, and treatment options are usually restricted to palliative systemic therapy. The impact of liver resection on metastasis remains controversial. The aim of this study is to investigate whether liver resection can offer better survival outcomes in cases of isolated liver metastases from breast cancer.
We conducted a nationwide cohort study using a claims dataset from Taiwan's National Health Insurance Research Database (NHIRD). We identified all patients with breast cancer (diagnostic code ICD-9: 174.x) from the Registry for Catastrophic Illness Patient Database (RCIPD) of the NHIRD who underwent mastectomy between January 1, 2000, and December 31, 2008. Patients with other malignancies (history, initially, or during follow-up), those with a history of metastasis prior to or at initial admission for mastectomy, and those without liver metastases were excluded. Patients with other metastases between mastectomy and liver metastasis and those who died at first admission for liver resection were also excluded. All patients were followed up until December 31, 2013, or withdraw from the database because of death.
Data were analyzed for 1,116 patients who fulfilled the inclusion criteria (resection group: 89; non-resection group: 1,027). There were no differences in age, Charlson Comorbidity Index, or major coexisting diseases except renal disease between two groups. Kaplan-Meier analysis demonstrated that the liver resection group had significantly better overall survival (OS) than the non-resection group. (1-year: 96.6% vs. 52.3%, 2-year: 86.8% vs. 35.4%, 3-year: 72.3% vs. 25.2%, 5-year: 51.6% vs. 16.9%, respectively, p<0.001). Cox analysis revealed that the liver resection group exhibited a significant improvement in patient survival (hazard ratio [HR] = 0.321, 95% confidence interval [CI]: 0.234-0.440, p<0.001).
These findings indicate that liver resection may offer better survival benefit in patients with breast cancer who develop new liver metastases post mastectomy.
乳腺癌肝转移预后不良，治疗方案通常仅限于姑息性全身治疗。肝切除术对转移的影响仍存在争议。本研究旨在探讨肝切除术是否能为乳腺癌孤立性肝转移患者带来更好的生存结果。
我们使用台湾全民健康保险研究数据库（NHIRD）的理赔数据集，进行了一项全国性队列研究。我们从 NHIRD 的灾难性疾病患者登记数据库（RCIPD）中确定了所有在 2000 年 1 月 1 日至 2008 年 12 月 31 日期间接受乳房切除术的乳腺癌（诊断代码 ICD-9：174.x）患者。排除了有其他恶性肿瘤病史（最初或随访期间）、乳房切除术初始时或之前有转移病史以及无肝转移的患者。排除了乳房切除术和肝转移之间有其他转移且首次肝切除术时死亡的患者。所有患者均随访至 2013 年 12 月 31 日或因死亡而退出数据库。
对符合纳入标准的 1116 名患者（切除术组：89 例；非切除术组：1027 例）进行了数据分析。两组之间在年龄、Charlson 合并症指数和主要并存疾病（除肾病外）方面无差异。Kaplan-Meier 分析表明，肝切除术组的总生存（OS）明显优于非切除术组。（1 年：96.6% vs. 52.3%，2 年：86.8% vs. 35.4%，3 年：72.3% vs. 25.2%，5 年：51.6% vs. 16.9%，p<0.001）。Cox 分析显示，肝切除术组患者的生存状况显著改善（风险比 [HR] = 0.321，95%置信区间 [CI]：0.234-0.440，p<0.001）。
这些发现表明，对于乳腺癌患者在乳房切除术后发生新的肝转移，肝切除术可能提供更好的生存获益。
