Association between the histopathological growth patterns of liver metastases and survival after hepatic surgery in breast cancer patients

Ali Bohlok,Peter Vermeulen,François Richard,Denis Larsimont,Maxim De Schepper,Jean‐Christophe Noël ,Elia Biganzoli,Valério Lucidi ,Christos Sotiriou,Luc Dirix,Lara Botzenhart,Sophia Leduc,Martine Piccart,Christine Desmedt,Steven Van Laere,Philippe Aftimos,Michail Ignatiadis,Alain Hendlisz,Tatjana Geukens,Emily Latacz,Vincent Donckier

doi:10.1038/s41523-020-00209-1

Abstract

Currently, there are no markers to identify patients with liver-only or liver-dominant metastases that would benefit from hepatic surgery. Here we characterized histopathological growth patterns (HGPs) of liver metastases in a consecutive series of 36 breast cancer patients who underwent hepatic surgery. Survival analyses showed that the presence of a desmoplastic HGP in the liver metastases (a rim of fibrous tissue separating cancer cells from the liver parenchyma, present in 20 (56%) patients) is independently associated with favorable progression-free and overall survival when compared with the replacement HGP (cancer cells growing into the liver parenchyma, present in 16 (44%) patients).

Highlights

There are no markers to identify patients with liver-only or liver-dominant metastases that would benefit from hepatic surgery
In metastases with a desmoplastic pattern (D-histopathological growth patterns (HGPs)), cancer cells are separated from liver cells by a rim of desmoplastic stroma, which is often densely infiltrated with inflammatory cells
We did not observe a correlation between the number of slides that were evaluated per patient and the percentage of R-HGP (Supplementary Fig. 2b)

Summary

Bohlok et al 2

More) desmoplastic, further referred to as “any D-HGP” and present in the remaining 20 patients (56%). ER estrogen receptor, HGP histological growth pattern (D desmoplastic, R replacement), IDC invasive ductal carcinoma, ILC invasive lobular carcinoma, LM liver metastasis, NST invasive carcinoma of no special type, P primary tumor, PgR progesterone receptor, TNM tumor–node–metastasis staging system. A first relevant finding is that a high fraction of these patients (44%) have LM with a pure R-HGP, whereas this pattern is only observed in 4–20% of the resected colorectal LM7–9 This indicates that the presence of the distinct HGPs may depend on the type of primary tumor. D-HGP may identify breast cancer patients who can be offered (repeated) hepatic surgery to prolong survival In this series, all patients with pure R-HGP LM rapidly relapsed within 2 years after surgery, indicating a more aggressive disease course and strongly questioning the role of surgery in these cases. This study emphasizes the need for studying LM from breast cancer patients in more detail to allow further personalization of local and systemic treatment for these patients in the near future

METHODS

Findings

Ethics approval