The role of surgical intervention for isolated breast cancer liver metastasis: Results of case‐control study with comparison to medical treatment

Abstract

BackgroundCombined with systemic therapy, the surgical intervention for breast cancer liver metastases (BCLM) is increasingly accepted but lacks convincing evidence. The aim of this study was to evaluate the disease control efficacy of hepatic surgery in isolated BCLM patients.MethodsBetween 2012 and 2017, metastatic breast cancer patients with isolated liver metastasis and regular follow‐up were identified. Cohort design was conducted to compare the progression‐free survival (PFS) between the surgical and nonsurgical BCLM patients. Univariate analysis and multivariate Cox regression survival analyses were performed to identify significant prognostic factors.ResultIn all, 148 isolated BCLM patients were enrolled and 95 participants received hepatic surgery for metastatic lesions. With median follow‐up of 36.47 months, there was no significant difference between hepatic surgical group and nonsurgical group for PFS (median PFS: 11.17 months vs 10.10 m, P = .092). Based on the multivariate analysis, the disease‐free interval (DFI) was an independent prognostic factor for isolated BCLM patients. Among the surgical group, BCLM patients who had ideal response after first salvage systemic treatment experienced the best long‐term survival (median PFS: 14.20 months).ConclusionFor isolated BCLM patients with ideal response in first‐line medical treatment, surgical intervention (hepatectomy, radiofrequency ablation) combining with systemic treatment could bring improved progression‐free survival compared to sole systemic treatment, indicating that hepatic surgery may be considered as a therapeutic choice for selected isolated BCLM patients in clinical practice.

Hepatic resection for breast cancer related liver metastases: A single institution experience

“…13 Two case matched studies have demonstrated improved survival for patients undergoing liver resection with systemic treatment versus systemic treatment alone, although another case control study has shown no difference in progression free survival between those undergoing surgery and those receiving systemic treatment only. [29][30][31] It seems plausible that a select cohort of patients will achieve a survival benefit from undergoing liver resection for BCLM and a recent meta-analysis has demonstrated a survival advantage for patients undergoing surgery combined with systemic therapy versus those receiving systemic therapy alone. 32 Several other reviews have produced conflicting reports about the evidence of hepatic resection for BCLM.…”

Breast cancer liver metastasis: time to resection and criteria

“…In the manuscript, Grazi shows no definitive proof of liver resections (LR) effectiveness for BCLM. However, the author suggests surgery may be possible in selected patients ( 1 - 3 ). Several retrospective case series have been published evaluating patients’ survival following resection for BCLM, reporting results for 5-year overall and disease-free survivals.…”

“…In the article, those criteria have been identified in radical surgery (margins R0) and saving at least 30% of the liver parenchyma that are general rules of thumb for LR in oncological diseases ( 1 ). Also, the stable skeletal disease could not be a contraindication to resection ( 1 , 4 ), and the only identified prognostic criterion is the interval treatment in metachronous hepatic disease (>24 months) ( 1 , 3 , 4 ). Some considerations in a complex and systemic disease such as BC should be made when treating this patient subgroup.…”

“…Advance in techniques and management of patients after LR have made liver surgery safe, effective with a low mortality rate and an acceptable complication rate. In addition, the studies have been published from a broad time interval with vast differences in medical and surgical treatment and a consequential impact on the results ( 3 , 4 ). Most resections (parenchyma sparing vs. anatomical resection) provide free margins ( 1 , 4 ).…”

“…Surgery could be an ideal treatment for isolated BCLM downstaged or stable after the first line of systemic treatment. A comparative study by Wen et al showed that the patients with low tumour burden, who are potential candidates for LR or local ablative therapies, had similar progression-free survival (PFS) with patients only receiving systemic therapy, indicating that hepatic surgical intervention could not provide survival benefits for all BCLM patients ( 3 ). Remarkably, BCLM patients who gained clinical benefit from the first-line endocrine or chemotherapy had a better PFS than those with progressive disease who underwent hepatic resection, and the patients only received systemic treatment ( 12 ).…”