Appropriate Surgical Selection in Patients with Breast Cancer Liver Metastases to Optimize Surgical Outcome: A Nomogram Based on a Multi-Institutional Experience

Abstract

Background: The key for success in BCLM is the selection of patients and the possibility to integrate the surgical option in a multidisciplinary treatment, hence the need to focus on the factors determining a patient's prognosis following hepatectomy and to develop a nomogram to predict oncological outcome. Methods: Using a multicentric database including patients who underwent hepatectomy for BCLM at three Italian HPB referral centers between 2000 and 2018, we sought to identify the predictors of survival and develop a clinical tool to predict patient's prognosis after liver resection for BCLM. Results: 154 undergoing surgery with curative intent were included in the analysis. Number of liver lesions (HR 1.66;95% CI, 1.01–2.67; p=0.035), tumor size (HR 1.71;95% CI, 1.22–2.97; p=0.019), triple negative status (HR = 1.07; 95% CI, 1.21 – 2.76; p=0.027), presence of extrahepatic metastases (HR=1.36; 95% CI, 1.19 – 2.91, p=0.032), response to preoperative chemotherapy (HR 1.97; 95% CI, 1.56 – 3.12; p=0.028) were the predictors of recurrence free survival. The beta-coefficients from the final multivariable model were utilized to develop a nomogram. The nomogram demonstrated a good ability to predict risk of recurrence (c-index of 0.741). Patients were stratified by Predicted Recurrence Risk (PRR) groupings: PRR <20%, PRR 20–40%, PRR 40–80%, PRR >80%, which correlated with disease free-survival at 3-year of 85%, 61%, 34%, and 0%, respectively. Conclusion: The developed nomogram accurately (c-index >75 %) staged and predicted the prognosis of patients undergoing liver resection for BCLM, providing an accurate tool to select candidates to liver resection.