Liver Metastasectomy for Metastatic Breast Cancer Patients: A Single Institution Retrospective Analysis.

Armando Orlandi,Alejandro Martin Sanchez,Felice Giuliante,Giovanna Garufi,Antonella Palazzo,Giampaolo Tortora,Emilio Bria,Maria Vellone,Claudia Cutigni,Alessandra Cassano,Gianluca Franceschini,Maria Chiara Cannizzaro,Caterina Mele,Letizia Pontolillo,Mariangela Pasqualoni,Francesco Ardito,Sergio Pannunzio

doi:10.3390/jpm11030187

Abstract

The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.

Highlights

Liver metastasis was metachronous for 17 patients and synchronous for 5 patients
Resection of breast cancer liver metastasis may represent a therapeutic option for selected patients
The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option [32] like in other neoplastic diseases [33]

Summary

Introduction

Metastatic breast cancer (MBC) is the first oncological cause of death in women despite the advances in therapeutic strategies, with a 5-year survival of only ~25% [1,2]. The liver represents the first metastatic site in 5–12% of MBC [3] cases. Despite the transient response to chemo or endocrine therapy, most patients experience disease progression after 1–2 years [4]. While current evidence supports a liver metastasectomy (LM) for advanced colorectal cancer in improving survival [5,6] on the basis that hepatic parenchyma filters circulating tumor cells (CTC) from the primary neoplastic site to systemic circulation, LM is considered a possible therapeutic option for selected MBC patients in clinical practice, in the absence of prospective evidence. Several studies reported controversial results about the survival rate after hepatic loco-regional treatment in MBC with liver metastases with a 3-year and 5-year survival rate that ranged between 49–94% and 5–78%

Methods

Results

Discussion

Conclusion