Zou Xuxiazi, Zou Hong-Liang, Luo Xuan, Chen Xu-Wei, Huang Wei-Ling, Zhang Chao, Ren Ge, Huang Jin-Hua, Han Xue, Jiang Yi-Quan
Department of Breast Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China.
Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University First Affiliated Hospital, Guangzhou 510080, PR China.
Breast. 2025 Feb;79:103876. doi: 10.1016/j.breast.2025.103876. Epub 2025 Jan 8.
Current decision-making for the treatment of breast cancer liver metastases (BCLM) using ablation lacks strong evidence, especially for patients combined with extrahepatic metastases.
To assess whether ablation plus systemic therapy (AS) improves survival outcomes in patients with BCLM compared to systemic therapy alone.
This retrospective study analyzed patients with BCLM who received either AS or systemic therapy alone. Propensity score matching (PSM) and survival analysis were performed, taking into account factors like the characteristics of primary breast cancer, liver metastases and systemic therapies received.
The study included 1021 female patients, with a median follow-up of 39.6 months. Of these patients, 132 underwent AS and 836 received systemic therapy alone. After PSM, among patients with BCLM (≤3 tumors, each ≤3 cm), the median overall survival (OS) for those treated with AS or systemic therapy alone was 65.5 and 40.4 months, respectively (HR = 0.48, p = .003); in the subset of patients with extrahepatic metastases, the median OS for those treated with AS and systemic therapy alone was 46.4 and 40.8 months, respectively (HR = 0.58, p = .047). Among patients with >3 cm or >3 lesions, the median OS for those treated with AS or systemic therapy alone was 45.2 and 29 months, respectively (HR = 0.67, p = .084).
Among patients with BCLM (≤3 tumors, each ≤3 cm), AS provide longer survival compared to systemic therapy alone, even with extrahepatic metastases. For patients with larger or more numerous metastases (>3 cm or >3 lesions), AS may provide survival benefit, but further validation is needed.
目前使用消融术治疗乳腺癌肝转移（BCLM）的决策缺乏有力证据，尤其是对于合并肝外转移的患者。
评估与单纯全身治疗相比，消融术联合全身治疗（AS）是否能改善BCLM患者的生存结局。
这项回顾性研究分析了接受AS或单纯全身治疗的BCLM患者。进行倾向评分匹配（PSM）和生存分析，同时考虑原发性乳腺癌的特征、肝转移情况以及接受的全身治疗等因素。
该研究纳入了1021名女性患者，中位随访时间为39.6个月。其中，132例接受了AS治疗，836例接受了单纯全身治疗。PSM后，在BCLM（≤3个肿瘤，每个≤3 cm）患者中，接受AS或单纯全身治疗的患者中位总生存期（OS）分别为65.5个月和40.4个月（HR = 0.48，p = 0.003）；在肝外转移患者亚组中，接受AS和单纯全身治疗的患者中位OS分别为46.4个月和40.8个月（HR = 0.58，p = 0.047）。在肿瘤直径>3 cm或病灶>3个的患者中，接受AS或单纯全身治疗的患者中位OS分别为45.2个月和29个月（HR = 0.67，p = 0.084）。
在BCLM（≤3个肿瘤，每个≤3 cm）患者中，与单纯全身治疗相比，AS可提供更长的生存期，即使是合并肝外转移的患者。对于转移灶更大或更多（>3 cm或>3个病灶）的患者，AS可能提供生存获益，但需要进一步验证。
