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Calpin GG, Davey MG, Calpin P, Browne F, Lowery AJ, Kerin MJ. The impact of liver resection on survival for patients with metastatic breast cancer - A systematic review and meta-analysis. Surgeon 2023; 21:242-249. [PMID: 36333192 DOI: 10.1016/j.surge.2022.10.001] [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: 05/26/2022] [Revised: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION There is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM). AIM To perform a systematic review and meta-analysis evaluating the role of liver resection for BCLM. METHODS A systematic review was performed as per PRISMA guidelines. Hazard ratio (HR) for overall survival (OS) and standard error was obtained from each study and expressed using the generic inverse variance method, with a corresponding 95% confidence interval (CI). OS outcomes at 1- 3- and 5-years were expressed as dichotomous variables and pooled as odds ratios (OR) using the Mantel-Haenszel method. RESULTS Nine studies with 1732 patients were included. Of these, 24.5% underwent surgical resection of BCLM (424/1732) and 75.5% did not (1308/1732). Overall, OS was significantly better among those who underwent surgery versus controls (HR: 0.69, 95% CI: 0.59-0.80, P < 0.00001). Mortality rates were significantly reduced at 1-year (7.5% (10/134) vs 20.3% (79/390), OR: 0.25, 95% CI: 0.08-0.74, P = 0.010) and 5-years (54.0% (190/352) vs 75.3% (940/1249), OR: 0.46, 95% CI: 0.25-0.87, P = 0.020) respectively for those undergoing surgery versus controls. Mortality rates at 3 years after surgery were lower than the control group (19.1% (29/152) vs 53.0% (222/419)), however this failed to achieve statistical significance at meta-analysis (OR: 0.32, 95% CI: 0.09-1.12, P = 0.070). CONCLUSION Liver resection may be considered at multidisciplinary meetings for those with BCLM and offers a potentially curative option. However, judicious patient selection is crucial prior to making decisions in relation to resection of BCLM.
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Affiliation(s)
- Gavin G Calpin
- Department of Surgery, University Hospital Galway, Galway, Ireland.
| | - Matthew G Davey
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Pádraig Calpin
- Department of Anaesthesiology, University Hospital Galway, Galway, Ireland
| | - Ferdia Browne
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Wu R, Gogineni K, Meisel J, Szabo S, Thirunavu M, Friend S, Bercu Z, Sethi I, Natarajan N, Switchenko J, Levy J, Abdalla E, Weakland L, Kalinsky K, Kokabi N. Study Protocol: Efficacy and Safety of Radioembolization (REM) as an Early Modality (EM) Therapy for Metastatic Breast Cancer (BR) to the Liver with Y90 (REMEMBR Y90). Cardiovasc Intervent Radiol 2022; 45:1725-1734. [PMID: 36008574 DOI: 10.1007/s00270-022-03254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The primary objective of the REMEMBR Y90 study is to evaluate the efficacy of Yttrium-90 (Y90) radioembolization in patients with breast cancer metastases to the liver as a 2nd or 3rd line treatment option with systemic therapy by assessing liver-specific and overall progression-free survival. Secondary objectives include quality of life, overall survival benefit, and toxicity in relation to patients' tumor biology. MATERIALS AND METHODS This trial is a multi-center, prospective, Phase 2, open-label, IRB-approved, randomized control trial in the final phases of activation. Eligible patients include those over 18 years of age with metastatic breast cancer to the liver with liver-only or liver-dominant disease, and history of tumor progression on 1-2 lines of chemotherapy. 60 patients will be randomized to radioembolization with chemotherapy versus chemotherapy alone. Permissible regimens include capecitabine, eribulin, vinorelbine, and gemcitabine within 2 weeks of enrollment for every patient. Patients receiving radioembolization will receive lobar or segmental treatment within 1-6 weeks of enrollment depending on their lesion. After final radioembolization, patients will receive clinical and imaging follow-up every 12-16 weeks for two years, including contrast-enhanced computed tomography or magnetic resonance imaging of the abdomen and whole-body positron emission tomography/computed tomography. DISCUSSION This study seeks to elucidate the clinical benefit and toxicity of Y90 in patients with metastatic breast cancer to the liver who are receiving minimal chemotherapy. Given previous data, it is anticipated that the use of Y90 and chemotherapy earlier in the metastatic disease course would improve survival outcomes and reduce toxicity. LEVEL OF EVIDENCE Level 1b, Randomized Controlled Trial. TRIAL REGISTRATION NUMBER NCT05315687 on clinicaltrials.gov.
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Affiliation(s)
- Richard Wu
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Jane Meisel
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Stephen Szabo
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Meenakshi Thirunavu
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Sarah Friend
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Zachary Bercu
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Neela Natarajan
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Jeffrey Switchenko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Jason Levy
- Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Eddie Abdalla
- Northside Hospital Cancer Institute, Atlanta, GA, USA
| | | | - Kevin Kalinsky
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Nima Kokabi
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
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Liu X, Xian Y, Xu H, Hu M, Che K, Liu X, Wang H. The associations between Deltex1 and clinical characteristics of breast cancer. Gland Surg 2021; 10:3116-3127. [PMID: 34926227 PMCID: PMC8637063 DOI: 10.21037/gs-21-739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 08/25/2023]
Abstract
BACKGROUND Deltex 1 (DTX1) is a single transmembrane protein with ubiquitin E3 ligase activity which has been found to play a role in the development of several cancers. We aimed to investigate the associations between DTX1 and breast cancer (BC). METHODS We explored the roles and mechanisms of DTX1 in BC by using BC cell lines in vitro. Levels of DTX1 in serum and tissues were determined in 316 patients with BC, 102 patients with fibroadenoma, and 113 healthy controls by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). The associations between DTX1 and clinical characteristics of BC were analyzed using multivariate analysis and Cox regression survival analysis. RESULTS Lower levels of DTX1 promoted BC cell proliferation, migration, and invasion. The cell growth and survival of BC might be regulated by DTX1 via the Notch signaling pathway. Levels of DTX1 in BC tissues were lower compared to fibroadenoma tissues and peri-neoplastic breast tissues (P<0.01). A lower level of DTX1 was shown to be associated with advanced tumor grade (P=0.017), advanced clinical stage (P=0.031), positive lymph node metastasis (LNM) (P=0.009), and high Ki-67 index (P=0.023). Lower DTX1 expression was recognized as an impact factor for metastasis-free survival (MFS) in BC. CONCLUSIONS Lower levels of DTX1 could promote BC cell proliferation and migration, and are associated with advanced BC. There is potential for DTX1 as a marker to assist the selection of new BC treatment.
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Affiliation(s)
- Xiaoyi Liu
- Breast Diseases Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuwei Xian
- Department of Ultrasonography, Qingdao Municipal Hospital, Qingdao, China
| | - Hongmei Xu
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meixiang Hu
- Department of Pathology, People’s Hospital of Qixia, Yantai, China
| | - Kui Che
- Qingdao Key Laboratory of Thyroid Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiangping Liu
- Medical Research Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haibo Wang
- Breast Diseases Center, the Affiliated Hospital of Qingdao University, Qingdao, China
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