Clinical course of breast cancer patients with liver metastases.

Abstract

Between June 1973 and November 1980, 1,171 patients with metastatic breast cancer were treated with various doxorubicin-containing regimens at our institution (M.D. Anderson Hospital and Tumor Institute, Houston). Retrospective analysis of all 233 cases (20%) with liver metastases was done to correlate various clinical and biochemical characteristics with response to treatment, survival, and causes of death. A similar analysis was performed for 58 consecutive patients with liver metastases treated at this hospital between December 1955 and December 1957 with hormone therapy or single-agent chemotherapy. Objective responses were observed in 132 of 233 patients (57%) treated with combination chemotherapy. The median survival was 14 months in the 1970s and 5 months in the 1950s. Among patients who had liver metastases at the time of initial diagnosis of breast cancer, survival was longer for the group treated with combination chemotherapy. All cases were classified according to the number of organ sites involved by metastases. Patients with only liver metastases, or liver plus bone lesions had the longest survival. Other clinical and biochemical factors that correlated significantly with longer survival were: no prior chemotherapy, performance status of 1 to 2, absence of ascites, normal bilirubin and lactic dehydrogenase (LDH), SGOT less than or equal to 2 times normal and albumin greater than 4.5 g/dL. The main cause of death was multiorgan failure, with only 20% of patients dying of liver failure. The present study shows that the presence of liver metastases in breast cancer is not by itself an ominous factor. Most patients respond to therapy, and significant palliation with extended survival is possible for several prognostic subgroups. Further improvement in length and quality of survival is expected with earlier diagnosis.

Clinical Characteristics and Survival Analysis of Breast Cancer Molecular Subtypes with Hepatic Metastases

“…In this study, hepatic metastases from breast cancer had a median survival time of 16.0 months which is similar to the results quoted by Wyld et al (Zinser et al, 1987;Wyld et al, 2003) and better than the findings of other studies (Patanaphan et al, 1988;O'Reilly et al, 1990;Hoe et al, 1991). On multivariate analysis in this study, hepatic metastatic interval after initial diagnosis, treatment with surgery, and endocrine therapy, which for hepatic metastases, were the independent prognostic factors for hepatic metastases breast cancer.…”

“…Hepatic metastasis is the one of the most frequency distant metastasis of breast cancer (Shibuya et al, 2002). Survival rate for patients with hepatic metastasis breast cancer was poor, with a median survival time about 14 months (Zinser et al, 1987).…”

Weekly epirubicin for breast cancer with liver metastases and abnormal liver biochemistry

“…We adjusted dose intensity according to myelosuppression; in this way any effect of decreased epirubicin clearance due to impaired liver function led to a delay in treatment and reduction in dose intensity. Few studies have been directed specifically at breast cancer patients with liver metastases (Zinser et al, 1987;O'Reilly et al, 1989). The majority of reports of chemotherapy in such patients have been derived from larger studies of patients with metastatic disease in a varity of sites.…”

“…Details of disturbances in liver biochemistry were not given, although abnormalities of liver biochemistry confer a poor prognosis (Swenerton et al, 1979;Zinser et al, 1987;O'Reilly et al, 1989). Indeed, many studies have specifically excluded patients with abnormal liver biochemistry although at least a third of breast cancer patients have a 2-fold or greater elevation in AST at the time of diagnosis of liver metastases (Zinser et al, 1987;S.M. O'Reilly, in preparation (Larroquette et al, 1986), and patients with hepatocellular carcinoma treated with mitoxantrone (Yoshida et al, 1988).…”

“…The prognosis is worse for these patients than after recurrence in either soft tissue (Fentiman et al, 1986) or bone (Coleman & Rubens, 1987). Survival is particularly poor in patients with liver metastases and abnormal liver biochemistry (Swenerton et al, 1979;Zinser et al, 1987;S.M. O'Reilly, in preparation). The treatment of patients with liver metastases is difficult.…”