Pronostic Factors after Breast Cancer Liver Metastases Surgery

Abstract

Introduction: Approximately, half of women with metastatic breast cancer will develop liver metastases (LM), however, the role of hepatic resection in these patients remains unclear. Method: Retrospective analysis of patients with LM from breast cancer who underwent liver surgery in our center between 2008-2020. Results: A total of 17 women were involved with an average age of 54.13 years (SD11.67). Breast tumor histology were: intraductal carcinoma (82.4%), adenocarcinoma (11.8%) and papillary carcinoma (5.9%). 64.7% of patients were estrogen-receptor-positive, 58.8% progesterone-receptor-positive and 11.8% Her2+. The median time from breast surgery to LM diagnosis was 31.52 months (IQR 88.52-13.88). Neoadjuvant therapy (NT) prior to liver resection was administered to 8 patients (47.1%), 75% of whom were responsive. Minor-hepatectomy was the most frequent resection performed, 14 patients (82.4%). The median DFS after liver surgery was 14.75 months (IQR 64.52-4), recurrence was identified in 9 patients (52.9%). (22.2% extrahepatic, 44.4% hepatic, 33.3% both). The prognostic factors which might have a negative influence on overall survival (OS) were T3 tumor (p=0.038), Her2+ (p=0.002), poorly differentiated tumors (p=0.057), synchronous LM (p=0.079), no response to NT before liver surgery (p=0.008) and an interval until LM appearance <72 months (p=0.048). Moreover, patients without neoadjuvant response (p=0.057) and an interval until LM appearance <72 months (p=0.049) showed a worse DFS after liver surgery. Conclusion: Breast cancer LM surgery is a valid procedure in selected cases. Response to NT, the interval until LM appearance, T3 tumors, Her2+, poorly differentiated breast cancer and synchronous LM are prognostic factors that we should take into account to select those women who may benefit from liver surgery.