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Cantalejo-Díaz M, Ramia JM, Álvarez-Busto I, Kokas B, Blanco-Fernández G, Muñoz-Forner E, Oláh A, Montalvá-Orón E, López-López V, Rotellar F, Eker H, Rijken A, Prieto-Calvo M, Romano F, Melgar P, Machairas N, Demirli Atici S, Castro-Santiago MJ, Lesurtel M, Skalski M, Bayhan H, Domingo-Del-Pozo C, Hahn O, de Armas-Conde N, Bauzá-Collado M, Serradilla-Martín M. Long-term outcomes after breast cancer liver metastasis surgery: A European, retrospective, snapshot study (LIBREAST STUDY). Surg Oncol 2024; 57:102129. [PMID: 39243418 DOI: 10.1016/j.suronc.2024.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/19/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Breast cancer (BC) is the most common malignant tumor in women. Between 20 % and 30 % of patients develop metastases from BC, 50 % of them in the liver. The mean survival rate reported in patients with liver metastases from BC (LMBC) ranges from 3 to 29 months. The role of surgery in LMBC is not clearly defined. The objective of the present study was to determine the long-term survival and disease-free survival of patients undergoing surgery for LMBC and to identify the patients who most likely benefit from surgery. MATERIAL AND METHODS This retrospective multicenter cohort study included all consecutive patients undergoing LMBC surgery at the participating European centers from January 1, 2010, to December 31, 2015. The ClinicalTrials.gov ID is NCT04817813. RESULTS A hundred women (mean age 52.6 years) undergoing LMBC surgery were included. Five-year disease-free survival was 29 %, and 5-year overall survival was 60 %. Median survival after BC surgery was 12.4 years, and after LMBC surgery, 7 years. Patients with ECOG 1, ASA score I-II, metachronous LMBC, positive hormone receptors, and who had received neoadjuvant and adjuvant hormone treatment obtained the best overall and disease-free survival results. CONCLUSIONS In cases of correct patient selection and as part of a comprehensive onco-surgical strategy, surgery for LMBC improves overall long-term survival. In our series, certain factors were linked to better disease-free and overall survival; consideration of these factors could improve the selection of the best candidates for LMBC surgery. CLINICALTRIALS GOV ID NCT04817813.
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Affiliation(s)
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, ISABIAL, Miguel Hernández University, Alicante, Spain.
| | - Iñaki Álvarez-Busto
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Balint Kokas
- Department of Surgery, Transplantation and Gastroenterology Semmelweis University, Budapest, Hungary
| | - Gerardo Blanco-Fernández
- Department of HPB Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | - Attila Oláh
- Department of Surgery, Aladar Petz Country Teaching Hospital, Gyor, Hungary
| | - Eva Montalvá-Orón
- Liver Surgery and Transplantation Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Víctor López-López
- Department of Surgery, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Hasan Eker
- Department of Surgery, University Hospital Ghent, Ghent, Belgium
| | - Arjen Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Mikel Prieto-Calvo
- Department of Surgery, Hepatobiliary Surgery and Liver Transplant Unit, BioCruces Health Research Institute, University of the Basque Country, Hospital Universitario de Cruces, Bizkaia, Spain
| | - Fabrizio Romano
- University of Milan-Bicocca UNIMIB, Department of Surgery and Interdisciplinary Medicine, Milan, Italy
| | - Paola Melgar
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Nikolaos Machairas
- Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Semra Demirli Atici
- Department of Surgery, University of Health Sciences, Tepecik Training and Research Hospital, Tepecik, Turkey
| | | | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, Clichy, France
| | - Michal Skalski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Hüseyin Bayhan
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Carlos Domingo-Del-Pozo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Oszkar Hahn
- Department of Surgery, Transplantation and Gastroenterology Semmelweis University, Budapest, Hungary
| | - Noelia de Armas-Conde
- Department of HPB Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs.GRANADA, School of Medicine, University of Granada, Granada, Spain
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Masuda Y, Yeo MHX, Syn NL, Goh BKP, Koh YX. Surgery for liver metastases from primary breast cancer: A reconstructed individual patient data meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107277. [PMID: 37995605 DOI: 10.1016/j.ejso.2023.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/24/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Currently, the outcomes of standard-of-care palliative treatment for BCLM remain poor. Recent literature has shown promising results of hepatic resection, however, not all studies concur. Given the lack of standardized international guidelines in this field, the aim of this study is to provide gold-standard evidence for breast cancer liver metastases (BCLM) through a reconstructed individual patient data meta-analysis approach. METHODS Four databases were searched for articles comparing surgical and non-surgical treatment for BCLM. One-stage meta-analysis was performed using patient-level survival data reconstructed from Kaplan-Meier curves with plot digitizer software. Shared-frailty and stratified Cox models were fitted to compare survival endpoints. RESULTS Four propensity-score matched (PSM) studies involving 205 surgical and 291 non-surgical patients for BCLM were included. There was a significant difference between both groups for overall survival (OS) (Hazard Ratio [HR] = 0.40, 95%CI 0.32-0.51). Sensitivity analyses for hormone receptor status of breast cancer (HR = 0.41, 95%CI 0.31-0.55) and type of resection performed (HR = 0.45, 95%CI 0.33-0.61) yielded HRs in favor of surgery. CONCLUSIONS This meta-analysis concludes that surgery offers superior OS outcomes, compared to non-surgery, in a select group of patients. Future randomized controlled trials and PSM studies are warranted, using this study as a point of reference for similar parameters.
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Affiliation(s)
- Yoshio Masuda
- Ministry of Health Holdings Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark H X Yeo
- Ministry of Health Holdings Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas L Syn
- Ministry of Health Holdings Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore; Surgery Academic Clinical Programme, Duke-NUS Medical School, Singapore.
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Rangarajan K, Lazzereschi L, Votano D, Hamady Z. Breast cancer liver metastases: systematic review and time to event meta-analysis with comparison between available treatments. Ann R Coll Surg Engl 2023; 105:293-305. [PMID: 35175853 PMCID: PMC10066639 DOI: 10.1308/rcsann.2021.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The current gold standard treatment for breast cancer liver metastases (BCLM) is systemic chemotherapy and/or hormonal therapy. Nonetheless, greater consideration has been given to local therapeutic strategies in recent years. We sought to compare survival outcomes for available systemic and local treatments for BCLM, specifically surgical resection and radiofrequency ablation. METHODS A review of the PubMed (MEDLINE), Embase and Cochrane Library databases was conducted. Data from included studies were extracted and subjected to time-to-event data synthesis, algorithmically reconstructing individual patient-level data from published Kaplan-Meier survival curves. FINDINGS A total of 54 studies were included, comprising data for 5,430 patients (surgery, n=2,063; ablation, n=305; chemotherapy, n=3,062). Analysis of the reconstructed data demonstrated survival rates at 1, 3 and 5 years of 90%, 65.9% and 53%, respectively, for the surgical group, 83%, 49% and 35% for the ablation group and 53%, 24% and 14% for the chemotherapy group (p<0.0001). CONCLUSION Local therapeutic interventions such as liver resection and radiofrequency ablation are effective treatments for BCLM, particularly in patients with metastatic disease localised to the liver. Although the data from this review support surgical resection for BCLM, further prospective studies for managing oligometastatic breast cancer disease are required.
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Affiliation(s)
| | - L Lazzereschi
- University Hospital Southampton NHS Foundation Trust, UK
| | - D Votano
- Ashford & St. Peter’s Hospitals NHS Foundation Trust, UK
| | - Z Hamady
- Ashford & St. Peter’s Hospitals NHS Foundation Trust, UK
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Meng Y, Pei HS, Yu JJ. Hyperlactemia associated with secondary hepatocellular carcinoma resection in relation to circulation stability and quality of recovery: A case report. World J Clin Cases 2023; 11:1869-1877. [PMID: 36970009 PMCID: PMC10037287 DOI: 10.12998/wjcc.v11.i8.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Intraoperative hyperlactatemia often affects circulatory stability, vital organ function, and postoperative recovery, poses a serious prognostic risk, and requires considerable attention from anesthesiologists. Here, we describe a case of hyperlactatemia during the postoperative resection of liver metastases after chemotherapy for sigmoid colon cancer. This did not affect the patient's circulatory stability or quality of awakening, which is rarely reported in clinical practice. We present our management experience with the aim of providing a reference for future studies and clinical practice.
CASE SUMMARY A 70-year-old female patient was diagnosed with postoperative liver metastasis following chemotherapy for sigmoid colon cancer. Laparoscopic right hemicolectomy and cholecystectomy under general anesthesia were required. Metabolic disorders, primarily hyperlactatemia, often occur intraoperatively. After treatment, other indices quickly returned to normal, lactate levels decreased slowly, and hyperlactatemia persisted during the awakening period. However, this did not affect the patient's circulatory stability or awakening quality. This condition has rarely been clinically reported. Therefore, we report our management experience in order to guide clinical practice in this regard. Hyperlactatemia did not affect circulatory stability or the quality of awakening. We considered that active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia due to insufficient tissue perfusion, while hyperlactatemia caused by decreased lactate clearance due to impaired liver function associated with surgical resection had a mild effect on the function of important organs.
CONCLUSION Active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia. Strengthening body temperature protection could improve lactate circulation.
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Affiliation(s)
- Yu Meng
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Huan-Shuang Pei
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jia-Jia Yu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Luk Y, She WH, Tsang SHY, Dai WC, Chan ACY, Cheung TT, Lo CM. Defining the surgical management for non-colorectal liver metastases. Langenbecks Arch Surg 2023; 408:35. [PMID: 36648566 DOI: 10.1007/s00423-023-02767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/30/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical resection is indicated for resectable colorectal liver metastases (CLM), but it is controversial for non-colorectal liver metastases (NCLM). This study aimed to compare survival outcomes of patients with resection of NCLM versus CLM and to identify prognostic factors for resection of NCLM. METHODS Consecutive patients who underwent surgical resection of liver metastases at Queen Mary Hospital, Hong Kong from January 1989 to December 2019 were retrospectively reviewed. Patients with resected NCLM were compared to those with CLM. Overall and recurrence-free survival were determined. Subgroup analyses with patients grouped according to the year of liver resection, from 1989 to 2004 and from 2005 to 2019, were conducted. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Among 674 patients included, 151 (22.4%) had NCLM while 523 (77.6%) had CLM. There were no statistically significant differences in median overall survival (65.2 vs 43.6 months, p = 0.555) and recurrence-free survival (12.5 vs 11.7 months, p = 0.425). The 1-year, 3-year, 5-year and 10-year overall survival rates were 89.8% vs 91.5%, 59.4% vs 58.8%, 50.6% vs 38.7% and 34.1% vs 26.3% in NCLM and CLM groups, respectively. Subgroup analyses demonstrated no statistically significant difference in overall survival between resection of NCLM versus CLM in both time intervals. In the NCLM group, better overall survival was found in liver metastasis of gastrointestinal stromal tumour (GIST) origin (hazard ratio (HR) 0.138, p = 0.003) and with a longer time interval from resection of primary tumour to resection of NCLM (HR 0.982, p = 0.042). Poor prognostic factors were presence of blood transfusion (HR 5.588, p = 0.013) and post-operative complications of Clavien-Dindo Grade IIIa or above (HR 74.853, p = 0.003). CONCLUSIONS Surgical resection of NCLM had comparable survival outcomes with CLM. With appropriate patient selection, the indication of liver resection could be expanded to NCLM.
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Affiliation(s)
- Yan Luk
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Wong Hoi She
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
| | - Simon H Y Tsang
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Wing Chiu Dai
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Albert C Y Chan
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Tan To Cheung
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
| | - Chung Mau Lo
- Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Karadeniz Cakmak G, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02. Ann Surg Oncol 2022; 29:6327-6336. [PMID: 35876920 DOI: 10.1245/s10434-022-12239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND One fourth of early-stage breast cancer cases become metastatic during the follow-up period. Limited metastasis is a metastatic disease condition in which the number of metastatic sites and the extent of the disease both are limited, and the disease is amenable to metastatic intervention. This prospective study aimed to evaluate intervention for limited metastases in the lung, liver, or both. METHODS The study enrolled luminal A/B and/or human epidermal growth factor receptor 2 (HER2)-neu+ patients with operable lung and/or liver metastases in the follow-up assessment after completion of primary breast cancer treatment and patients with a diagnosis of metastasis after 2014. Demographic, clinical, tumor-specific, and metastasis detection-free interval (MDFI) data were collected. Bone metastasis in addition to lung and liver metastases also was included in the analysis. The patients were divided into two groups according to the method of treatment for metastases: systemic therapy alone (ST) group or intervention (IT) group. RESULTS Until June 2020, 200 patients were enrolled in the study. The demographic data were similar between the two groups. The median follow-up time was 77 months (range 55-107 months) in the IT group (n = 119; 59.5%) and 57 months (range 39-84) in the ST-only group (n = 81; 40.5%). The median MDFI was 40 months (range 23-70 months) in the IT group, and 35 months (range 13-61 months) in the ST-only group (p = 0.47). The groups had similar surgeries for the primary tumor and axilla. Most of the patients had liver metastases (49.5%, n = 99), and 42% (n = 84) of the patients had lung metastases. Both lung and liver metastases were found in 8.5% (n = 17) of the patients. The primary tumor was estrogen receptor/progesterone receptor-positive in 75% (n = 150) of the patients, and 32% (n = 64) of the patients had HER2-neu+ tumors. Metastatic-site resection was performed for 32% (n = 64) of the patients, and 27.5% (n = 55) of the patients underwent metastatic ablative interventions. In the Kaplan-Meier survival analysis, the hazard of death (HoD) was 56% lower in the IT group than in the ST-only group (hazard ratio [HR], 0.44; 95% confidence interval [CI] 0.26-0.72; p = 0.001). The HoD was lower in the IT group than in the ST-only group for the patients younger than 55 years (HR, 0.32; 95% CI 0.17-0.62; p = 0.0007). In the multivariable Cox regression model, HoD was significantly lower for the patients who underwent intervention for metastases and had an MDFI longer than 24 months, but their liver metastases doubled the risk of death compared with lung metastases. CONCLUSION Metastasis-directed interventions have reduced the risk of death for patients with limited lung/liver metastases who are amenable to interventions after completion of primary cancer treatment. For a select group of patients, such as those with luminal A/B or HER2-neu+ breast cancer who are younger than 55 years with limited metastases to the lung and liver or an MDFI longer than 24 months, surgical or ablative therapy for metastases should be considered and discussed on tumor boards.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - S Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - B Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - L Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - K Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - H Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.,Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - O Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - G Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - K Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - M Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Y A Sezer
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - S Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - E Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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Prognostic Factors in Patients with Breast Cancer Liver Metastases Undergoing Liver Resection: Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14071691. [PMID: 35406462 PMCID: PMC8997076 DOI: 10.3390/cancers14071691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Robust predictive and prognostic tools are needed in the management of breast cancer liver metastases (BCLMs). Until now, surgery has not been the gold standard of treatment of patients with BCLMs. The present manuscript highlights several predictive factors related to the primary tumor and the BCLM that may help to identify candidates for surgery with favorable outcomes in a large cohort of patients. Abstract Background: The role of surgical resection of liver metastases in patients with breast cancer liver metastasis (BCLM) remains controversial. A systematic review and meta-analysis of prognostic factors related to survival after BCLM resection was performed. Methods: An electronic search of relevant publications was performed. Pooled outcome measures were expressed as hazard ratios (HRs), including 95% confidence interval values (95% CIs), and calculated through a random-effects model. Heterogeneity was tested through the I2 index. Results: Thirty-five publications reported analyses on prognostic factors and survival. A total of 2782 patients who underwent liver resection for BCLM were included. Positive axillary lymph nodes at breast cancer diagnosis were an unfavorable survival factor (HR 1.74, 95% CI 1.25 to 2.41, I2 = 0%). Cumulative predictive factor HRs (multiple liver metastases, size of the metastases, short interval between primary tumor and onset of liver disease) related to the BCLM pattern were 1.32 (95% CI 1.17 to 1.48, I2 = 71%) and 1.51 (95% CI 1.15 to 1.98, I2 = 76%) for surgical and pathological features (resection margin and presence of extrahepatic disease), respectively. Conclusion: Resection of BCLM may provide a survival benefit for selected patients. For better long-term results, surgical selection should consider both primary tumor and BCLM features such as negative axillary lymph nodes at breast resection, a single hepatic lesion, a time longer than 24 months between breast and hepatic diagnosis, and a realizable R0 liver resection. However, the high heterogeneity among studies suggests the need for an RCT to validate the present findings.
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Zhao GS, Liu S, Liu Y, Ma J, Wang RY, Bian J, Zhou J, Wu JL, Zhang YW. Clinical application of gelatin sponge microparticles combined with pirarubicin for hepatic transcatheter arterial chemoembolization in breast cancer liver metastasis treatment: results of a single-center long-term study. World J Surg Oncol 2021; 19:249. [PMID: 34419064 PMCID: PMC8380398 DOI: 10.1186/s12957-021-02332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To retrospectively analyze the safety and long-term clinical efficacy of gelatin sponge microparticles combined with the chemotherapy drug pirarubicin for hepatic transcatheter arterial chemoembolization (GSMs-TACE) in order to treat breast cancer liver metastasis (BCLM). Methods Twenty-seven BCLM patients who underwent GSMs-TACE from July 2010 to July 2016 were enrolled. Tumor target blood vessels were slowly and regionally embolized with absorbable gelatin sponge particles and pirarubicin injections. Plain computed tomography (CT) scans and biochemical indexes were re-examined at 4 days after treatment, and enhanced CT scans or magnetic resonance images and biochemical indexes, 1 month later. For patients with stable tumors, the follow-up period was 2 to 3 months, and the tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors. Adverse reactions, survival time, and prognostic factors were assessed. Results By October 2019, 27 patients with BCLM had undergone GSMs-TACE, with an average of 2.44 ± 1.58 treatments. The 1-, 3-, and 5-year survival rates were 62.96%, 22.22%, and 14.81%, respectively, and the mOS was 22.0 months. No serious complications, such as acute liver failure and liver abscess, had occurred. There were two cases of acute cholecystitis that recovered after symptomatic treatment. Multivariate analysis of the prognosis showed that the primary tumor size, number of metastatic lymph nodes, estrogen receptor/progesterone receptor (ER/PR) status, and time to postoperative liver metastasis and combination therapy were statistically significant. Conclusions The overall prognosis of BCLM was poor. GSMs-TACE was safe and effective for BCLM treatment and could prolong the median survival time of patients. Therefore, it is worthy of widespread clinical application.
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Affiliation(s)
- Guang Sheng Zhao
- Interventional Medicine Center, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jie Fang Street, Dalian, 116001, Liaoning Province, China
| | - Song Liu
- Interventional Medicine Center, Linyi Cancer Hospital, 6 East Lingyuan Street, Linyi, 276001, Shandong Province, China
| | - Ying Liu
- Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, 168 Litang Road, Beijing, 102218, Changping District, China
| | - Jian Ma
- Interventional Medicine Center, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jie Fang Street, Dalian, 116001, Liaoning Province, China
| | - Ruo Yu Wang
- Cancer Treatment Center, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Jie Bian
- Medical Imaging Center, The Second Hospital of Dalian Medical University, No. 467 Zhongshan Raod, Shahekou District, Dalian, 116044, Liaoning Province, China
| | - Jun Zhou
- Interventional Medicine Center, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jie Fang Street, Dalian, 116001, Liaoning Province, China.
| | - Jian Lin Wu
- Medical Imaging Center, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jie Fang Street, Dalian, 116001, Liaoning Province, China.
| | - Yue Wei Zhang
- Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, 168 Litang Road, Beijing, 102218, Changping District, China.
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Rivera K, Jeyarajah DR, Washington K. Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review. Front Oncol 2021; 11:643383. [PMID: 33842354 PMCID: PMC8033007 DOI: 10.3389/fonc.2021.643383] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background The liver is the second most common site of breast cancer metastasis. Liver directed therapies including hepatic resection, radiofrequency ablation (RFA), transarterial chemo- and radioembolization (TACE/TARE), and hepatic arterial infusion (HAI) have been scarcely researched for breast cancer liver metastasis (BCLM). The purpose of this review is to present the known body of literature on these therapies for BCLM. Methods A systematic review was performed with pre-specified search terms using PubMed, MEDLINE, EMBASE, and Cochrane Review resulting in 9,957 results. After review of abstracts and application of exclusion criteria, 51 studies were included in this review. Results Hepatic resection afforded the longest median overall survival (mOS) and 5-year survival (45 mo, 41%) across 23 studies. RFA was presented in six studies with pooled mOS and 5-year survival of 38 mo and 11–33%. Disease burden and tumor size was lower amongst hepatic resection and RFA patients. TACE was presented in eight studies with pooled mOS and 1-year survival of 19.6 mo and 32–88.8%. TARE was presented in 10 studies with pooled mOS and 1-year survival of 11.5 mo and 34.5–86%. TACE and TARE populations were selected for chemo-resistant, unresectable disease. Hepatic arterial infusion was presented in five studies with pooled mOS of 11.3 months. Conclusion Although further studies are necessary to delineate appropriate usage of liver directed therapies in BCLM, small studies suggest hepatic resection and RFA, in well selected patients, can result in prolonged survival. Longitudinal studies with larger cohorts are warranted to further investigate the effectiveness of each modality.
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Affiliation(s)
- Kevin Rivera
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Dhiresh Rohan Jeyarajah
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Kimberly Washington
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
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Millen JCA, Hofmann A, Mesquita-Neto JW, Rose J, Macedo FI. Evolving Role of Liver Resection in Selected Patients With Metastatic Breast Cancer. J Surg Res 2020; 259:363-371. [PMID: 33189360 DOI: 10.1016/j.jss.2020.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/12/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND More effective chemotherapy regimens combined with metastasectomy have improved overall survival (OS) in several cancer populations. The value of liver resection (LR) in breast cancer liver metastasis (BCLM) remains controversial. We sought to investigate the role of LR in BCLM as a therapeutic option in patients with isolated liver metastasis. METHODS The National Cancer Data Base (NCDB) was queried for patients with BCLM diagnosed from 2010 to 2014. The primary outcome was the OS. Kaplan-Meier and Cox proportional hazards regression were performed for intergroup comparison. RESULTS A total of 9244 patients with BCLM were included. The median age was 58 y (IQR 49-68 y). Of them, 2632 (28.5%) patients had isolated liver metastasis, 1957 (78.2%) received chemotherapy, 93 (3.6%) underwent LR, and only 83 (3.2%) received chemotherapy and LR. Median OS for the entire cohort and for patients with isolated BCLM was 18.3 mo and 29 mo, respectively. Chemotherapy with LR was associated with superior OS compared to chemotherapy alone (69.7 versus 49.2 mo, P < 0.001) in patients with BCLM: ER+ (69.6 versus 54.1 mo, P = 0.002) and triple-negative BC (49.2 versus 17.6 mo, P = 0.006). Cox regression showed that LR, chemotherapy, and positive hormone receptor status (ER+, PR+, and/or HER2+) were independent predictors of improved OS. Advanced age and comorbidity score negatively impacted OS. CONCLUSIONS This is the largest series thus far assessing the role of LR in patients with BCLM. LR plus chemotherapy may be associated with acceptable outcomes in selected patients with BCLM. LR should be considered in patients with isolated BCLM who had a good response to systemic therapy.
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Affiliation(s)
- Janelle-Cheri A Millen
- The Department of Surgery, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, Florida
| | - Alana Hofmann
- The Department of Surgery, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, Florida
| | - Jose Wilson Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jeffrey Rose
- The Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, Florida
| | - Francis I Macedo
- The Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, Florida.
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