Skip to main content

Advertisement

SpringerLink
Log in

Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast cancer liver metastases (BCLM) are considered the most lethal compared with other sites of metastases in patients with breast cancer. This study aimed to evaluate the outcome after hepatectomy for BCLM within current multidisciplinary treatment and to develop a clinically useful nomogram to predict survival.

Methods

Between January 1985 and December 2012, 139 consecutive female patients underwent liver resection for BCLM at the authors’ institution. Clinicopathologic data were collected and analyzed for survival outcome with determination of prognostic factors. A nomogram to predict survival was developed based on a multivariate Cox model. The predictive performance of the model was assessed according to the C-statistic and calibration plots.

Results

After a median follow-up period of 55 months, the overall 3- and 5-year survival rates after hepatectomy were respectively 58 and 47 %. The median overall survival period was 56 months, and the median disease-free survival period after surgical resection was 33 months. A single hepatic metastasis, no triple negative tumors, no microscopic vascular invasion, and perioperative hormonal or targeted therapy were related to improved overall survival. The model achieved good discrimination and calibration, with a C-statistic of 0.80.

Conclusions

Liver resection for selected patients with breast cancer metastases can provide significant survival benefit. It should be part of a multidisciplinary treatment program in experienced liver surgery centers. The authors’ nomogram facilitates personalized assessment of prognosis for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    Article  CAS  PubMed  Google Scholar 

  2. Ge Q-D, Lv N, Kong Y-N, et al. Clinical characteristics and survival analysis of breast cancer molecular subtypes with hepatic metastases. Asian Pacific J Cancer Prev. 2012;13:5081–6.

    Article  Google Scholar 

  3. Lobbezoo DJ, van Kampen RJ, Voogd AC, et al. Prognosis of metastatic breast cancer subtypes: the hormone receptor/HER2-positive subtype is associated with the most favorable outcome. Breast Cancer Res Treat. 2013;141:507–14.

    Article  CAS  PubMed  Google Scholar 

  4. 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 Clin Oncol. 1990;26:574–7.

    Article  Google Scholar 

  5. Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol. 2004;22:3302–8.

    Article  PubMed  Google Scholar 

  6. Chia SK, Speers CH, D’Yachkova Y, et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer. 2007;110:973–9.

    Article  PubMed  Google Scholar 

  7. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2001;235:759–66.

    Article  Google Scholar 

  8. Adam R, Aloia T, Krissat J, et al. Is liver resection justified for patients with hepatic metastases from breast cancer? Ann Surg. 2006;244:897–907 (discussion 907–8).

  9. Caralt M, Bilbao I, Cortes J, et al. Hepatic resection for liver metastases as part of the “oncosurgical” treatment of metastatic breast cancer. Ann Surg Oncol. 2008;15:2804–10.

    Article  PubMed  Google Scholar 

  10. Kollmar O, Moussavian MR, Richter S, et al. Surgery of liver metastasis in gynecological cancer: indication and results. Onkologie. 2008;31:375–9.

    Article  PubMed  Google Scholar 

  11. Lubrano J, Roman H, Tarrab S, et al. Liver resection for breast cancer metastasis: does it improve survival? Surg Today. 2008;38:293–9.

    Article  PubMed  Google Scholar 

  12. Thelen A, Benckert C, Jonas S, et al. Liver resection for metastases from breast cancer. J Surg Oncol. 2008;97:25–9.

    Article  PubMed  Google Scholar 

  13. Hoffmann K, Franz C, Hinz U, et al. Liver resection for multimodal treatment of breast cancer metastases: identification of prognostic factors. Ann Surg Oncol. 2010;17:1546–54.

    Article  PubMed  Google Scholar 

  14. Rubino A, Doci R, Foteuh JC, et al. Hepatic metastases from breast cancer. Updates Surg. 2010;62:143–8.

    Article  PubMed  Google Scholar 

  15. Cassera MA, Hammill CW, Ujiki MB, et al. Surgical management of breast cancer liver metastases. HPB Oxford. 2011;13:272–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Abbott DE, Brouquet A, Mittendorf EA, et al. Resection of liver metastases from breast cancer: estrogen receptor status and response to chemotherapy before metastasectomy define outcome. Surgery. 2012;151:710–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Duan XF, Dong NN, Zhang T, et al. Comparison of surgical outcomes in patients with colorectal liver metastases versus noncolorectal liver metastases: a Chinese experience. Hepatol Res. 2012;42:296–303.

    Article  PubMed  Google Scholar 

  18. Groeschl RT, Nachmany I, Steel JL, et al. Hepatectomy for noncolorectal non-neuroendocrine metastatic cancer: a multi-institutional analysis. J Am Coll Surg. 2012;214:769–77.

    Article  PubMed  Google Scholar 

  19. van Walsum GA, de Ridder JA, Verhoef C, et al. Resection of liver metastases in patients with breast cancer: survival and prognostic factors. Eur J Surg Oncol. 2012;38:910–7.

    Article  PubMed  Google Scholar 

  20. Dittmar Y, Altendorf-Hofmann A, Schule S, et al. Liver resection in selected patients with metastatic breast cancer: a single-centre analysis and review of literature. J Cancer Res Clin Oncol. 2013;139:1317–25.

    Article  CAS  PubMed  Google Scholar 

  21. Kostov DV, Kobakov GL, Yankov DV. Prognostic factors related to surgical outcome of liver metastases of breast cancer. J Breast Cancer. 2013;16:184–92.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Polistina F, Costantin G, Febbraro A, et al. Aggressive treatment for hepatic metastases from breast cancer: results from a single center. World J Surg. 2013;37:1322–32.

    Article  CAS  PubMed  Google Scholar 

  23. Kim JY, Park JS, Lee SA, et al. Does liver resection provide long-term survival benefits for breast cancer patients with liver metastasis? A single hospital experience. Yonsei Med J. 2014;55:558–62.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Weinrich M, Weiss C, Schuld J, et al. Liver resections of isolated liver metastasis in breast cancer: results and possible prognostic factors. HPB Surg. 2014;2014:893829.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Couinaud C. Variations of the right bile ducts: the futility of complete anatomical classifications. Chirurgie. 1993;1993; 119:354–6.

    Google Scholar 

  26. Ruiz A, Castro-Benitez C, Sebagh M, et al. Repeat Hepatectomy for Breast Cancer Liver Metastases. Ann Surg Oncol. 2015;22:1057–66.

    Article  Google Scholar 

  27. Zlotnik A, Abraira V. A general-purpose nomogram generator for predictive logistic regression models. Stata J. 2015;15:537–46.

    Google Scholar 

  28. Abuzallouf S, Motawy M, Thotathil Z. Baseline staging of newly diagnosed breast cancer: Kuwait cancer control center experience. Med Princ Pract. 2007;16:22–4.

    Article  PubMed  Google Scholar 

  29. Schuetz F, Diel IJ, Pueschel M, et al. Reduced incidence of distant metastases and lower mortality in 1072 patients with breast cancer with a history of hormone replacement therapy. Am J Obstet Gynecol. 2007;196:342 e1–9.

    Google Scholar 

  30. Kennecke H, Yerushalmi R, Woods R, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010;28:3271–7.

    Article  PubMed  Google Scholar 

  31. Pogoda K, Niwinska A, Murawska M, et al. Analysis of pattern, time, and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol. 2013;30:388.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Berman AT, Thukral AD, Hwang WT, et al. Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment. Clin Breast Cancer. 2013;13:88–94.

    Article  PubMed  Google Scholar 

  33. Follana P, Barriere J, Chamorey E, et al. Prognostic factors in 401 elderly women with metastatic breast cancer. Oncology. 2014;86:143–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The Netherlands Organization for Scientific Research (NWO) provided funding for a research fellow.

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France

    Aldrick Ruiz MD, Mylène Sebagh MD, Sylvie Giacchetti MD, Carlos Castro-Benitez MD, Bernard Paule MD, Denis Castaing MD & René Adam MD, PhD

  2. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Aldrick Ruiz MD & Richard van Hillegersberg MD, PhD

  3. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Dennis A. Wicherts MD, PhD

  4. Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France

    Sylvie Giacchetti MD

  5. Department of Surgery, Hospital Mexico, San José, Costa Rica

    Carlos Castro-Benitez MD

  6. Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France

    Bernard Paule MD & Jean-François Morère MD

  7. Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France

    Denis Castaing MD

  8. Université Paris-Sud, UMR-S 785, 94804, Villejuif, France

    Jean-François Morère MD & René Adam MD, PhD

Authors
  1. Aldrick Ruiz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis A. Wicherts MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mylène Sebagh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sylvie Giacchetti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlos Castro-Benitez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard van Hillegersberg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bernard Paule MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Denis Castaing MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jean-François Morère MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. René Adam MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to René Adam MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 91 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ruiz, A., Wicherts, D.A., Sebagh, M. et al. Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results. Ann Surg Oncol 24, 535–545 (2017). https://doi.org/10.1245/s10434-016-5522-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5522-7

Keywords

Search

Navigation