Prognostic Factors in Patients with Breast Cancer Liver Metastases (BCLM) Undergoing Liver Resection: Systematic Review and Meta-Analysis

Abstract

Introduction: Surgical treatment of Breast Cancer Liver Metastasis (BCLM) is debated. We perform a systematic review and meta-analysis of prognostic factors on survival after hepatic resection for BCLM. Methods: An electronic search was performed using PubMed/MEDLINE and Cochrane library databases. Two independent reviewers screened the titles and abstracts. Qualitative and quantitative evaluation of included studies was performed. The pooled effect was calculated using the random-effects model. Results: Thirty-five publications reported analysis on the role of prognostic factors influencing survival after hepatic resection for BCLM and were included in the meta-analysis. Two thousand seven hundred eighty-two patients underwent liver resection for BCLM. The positivity of the axillary lymph nodes at breast cancer diagnosis and the negative Estrogen Receptor status were survival unfavorable factors (HR 1.74, CI 95% 1.25 to 2.41, I2=0% and HR 2.09, CI 95% 1.40 to 3.12, I2=0%). Cumulative HR for predictive factors (multiple liver metastases, size of the metastasis, short interval between primary tumour and onset of liver disease, resection margin and presence of extrahepatic disease) related to the BCLM pattern was 1.32 (CI 95% 1.17 to 1.48, I2=71%) and 1.51 (CI 95% 1.15 to 1.98, I2=76%) for surgical and pathological features. Conclusion: Surgical treatment of BCLM is an option with survival advantages for selected patients. For better long-term results, surgical selection should consider both primary tumour and BCLM features. N0 stage at breast diagnosis, metachronous disease limited to the liver, single BCLM, and highly achievable R0 liver resection may determine the ideal candidate to resection.