Abstract
Background: Metastatic breast cancer is generally believed to be associated with a poor prognosis. Therapeutic advances over the past two decades, however, have resulted in improved outcomes for selected patients with limited metastatic disease.
Methods: Between March 1991 and October 2002, 31 patients had hepatic resection for breast cancer metastases limited to the liver. Clinical and pathologic data were collected prospectively from breast and hepatobiliary databases.
Results: Median age of patients was 46 years (range, 31 to 70). Liver metastases were solitary in 20 patients and multiple in 11 patients. Median size of the largest liver metastasis was 2.9 cm (range, 1 to 8). Major liver resections (three or more segments resected) were performed in 14 patients, whereas minor resections (fewer than three segments resected) with or without radiofrequency ablation (RFA) were performed in 17 patients. No postoperative mortality occurred. Of the 31 patients, 27 (87%) received either preoperative or postoperative systemic therapy as treatment for metastatic disease. The median survival was 63 months; a single patient died within 12 months of hepatic resection. The overall 2- and 5-year survival rates were 86% and 61%, respectively, whereas the 2- and 5-year disease-free survival rates were 39% and 31%, respectively. No treatment- or patient-specific variables were found to correlate with survival rates.
Conclusions: In selected patients with liver metastases from breast cancer, an aggressive surgical approach is associated with favorable long-term survival. Hepatic resection should be considered a component of multimodality treatment of breast cancer in these patients.
REFERENCES
Jardines L, Callans LS, Torosian MH. Recurrent breast cancer: presentation, diagnosis, and treatment. Semin Oncol 1993;20:538–47.
Wyld L, Gutteridge E, Pinder SE, et al. Prognostic factors for patients with hepatic metastases from breast cancer. Br J Cancer 2003;89:284–90.
Hoe AL, Royle GT, Taylor I. Breast liver metastases—incidence, diagnosis and outcome. J R Soc Med 1991;84:714–6.
O’Reilly SM, Richards MA, Rubens RD. Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival. Eur J Cancer 1990;26:574–7.
Patanaphan V, Salazar OM, Risco R. Breast cancer: metastatic patterns and their prognosis. South Med J 1988;81:1109–12.
Samaan NA, Buzdar AU, Aldinger KA, et al. Estrogen receptor: a prognostic factor in breast cancer. Cancer 1981;47:554–60.
Singletary SE, Walsh G, Vauthey JN, et al. A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist 2003;8:241–251.
Selzner M, Morse MA, Vredenburgh JJ, Meyers WC, Clavien PA. Liver metastases from breast cancer: long-term survival after curative resection. Surgery 2000;127:383–9.
Schneebaum S, Walker MJ, Young D, Farrar WB, Minton JP. The regional treatment of liver metastases from breast cancer. J Surg Oncol. 1994;55:26–31, discussion 32.
Ballantyne GH, Quin J. Surgical treatment of liver metastases in patients with colorectal cancer. Cancer 1993;71:4252–66.
Fuhrman GM, Curley SA, Hohn DC, Roh MS. Improved survival after resection of colorectal liver metastases. Ann Surg Oncol 1995;2:537–41.
Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 1999;230:1–8.
Zinser JW, Hortobagyi GN, Buzdar AU, Smith TL, Fraschini G. Clinical course of breast cancer patients with liver metastases. J Clin Oncol 1987;5:773–82.
Gayowski TJ, Iwatsuki S, Madariaga JR, et al. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 1994;116:703–10.
Elias D, Lasser PH, Montrucolli D, Bonvallot S, Spielmann M. Hepatectomy for liver metastases from breast cancer. Eur J Surg Oncol 1995;21:510–13.
Pocard M, Pouillart P, Asselain B, Falcou MC, Salmon RJ. Hepatic resection for breast cancer metastases: results and prognosis (65 cases). Ann Chir 2001;126:413–20.
Foster JH. Survival after liver resection for secondary tumors. Am J Surg 1978;135:389–94.
Wolf RF, Goodnight JE, Krag DE, Schneider PD. Results of resection and proposed guidelines for patient selection in instances of non-colorectal hepatic metastases. Surg Gynecol Obstet 1991;173:454–60.
Pocard M, Pouillart P, Asselain B, Salmon R. Hepatic resection in metastatic breast cancer: results and prognostic factors. Eur J Surg Oncol 2000;26:155–9.
Rose C, Dose J, Avril N. Positron emission tomography for the diagnosis of breast cancer. Nucl Med Commun 2002;23:613–18.
Scaife CL, Curley SA. Complication, local recurrence, and survival rates after radiofrequency ablation for hepatic malignancies. Surg Oncol Clin N Am 2003;12:243–55.
Stehlin JS Jr., Hafstrom L, Greeff PJ. Experience with infusion and resection in cancer of the liver. Surg Gynecol Obstet 1974;138:855–63.
Elias D, Lasser P, Spielmann M, et al. Surgical and chemotherapeutic treatment of hepatic metastases from carcinoma of the breast. Surg Gynecol Obstet 1991;172:461–4.
Lorenz M, Wiesner J, Staib-Sebler E, Encke A. Regional therapy breast cancer liver metastases. Zentralbl Chir 1995;120:786–90.
Yoshimoto M, Sugitani I, Iwase T, Watanabe S, Kasumi F. Therapeutic efficacy of hepatectomy in the treatment of hepatic metastases from breast cancer. Nippon Geka Gakkai Zasshi 1995;96:174–9.
Raab R, Nussbaum KT, Werner U, Pichlmayr R. Liver metastases in breast carcinoma. Results of partial liver resection. Chirurg 1996;67:234–7.
Seifert JK, Weigel TF, Gonner U, Bottger TC, Junginger T. Liver resection for breast cancer metastases. Hepatogastroenterology 1999;46:2935–40.
Maksan SM, Lehnert T, Bastert G, Herfarth C. Curative liver resection for metastatic breast cancer. Eur J Surg Oncol 2000;26:209–12.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vlastos, G., Smith, D.L., Singletary, S.E. et al. Long-term Survival After An Aggressive Surgical Approach in Patients With Breast Cancer Hepatic Metastases. Ann Surg Oncol 11, 869–874 (2004). https://doi.org/10.1245/ASO.2004.01.007
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2004.01.007