Resection of liver metastases tied to longer survival in breast cancer patients

Last Updated: 2020-03-19

By Lisa Rapaport

(Reuters Health) - Women with breast cancer metastasis to the liver who receive hepatic resection survive longer than those who don't, a recent analysis suggests.

Researchers used propensity score matching to compare 65 breast cancer patients who had surgery for liver metastases with 319 similar patients who did not undergo hepatic resection.

The mean overall survival (OS) and the 1-, 3-, and 5-year OS rates in the hepatic resection group were 61.8 months, 92.6%, 54.7%, and 54.7%, respectively. That compares with 38.6 months, 79.2%, 45.6%, and 21.9%, respectively in the group that received systemic therapy without hepatic resection.

In multivariate analysis, hormonal receptor status (p=0.039) and hepatic resection (p=0.032) were independent prognostic factors, the researchers report in the American Journal of Surgery.

"Current guidelines support only systemic therapy," said Dr. Elias Obeid, interim chief of breast medical oncology at the Fox Chase Cancer Center in Philadelphia.

"This study showed benefit for liver metastasectomy," Dr. Obeid, who wasn't involved in the study, said by email.

Up to 40% of women with breast cancer will develop metastatic lesions, most often in the bone, liver, lungs and brain, Dr. Lu Wang of Fudan University Shanghai Cancer Center and colleagues write in their report.

The standard treatment of breast cancer liver metastases is systemic therapy, and the median overall survival is only about three years, the study team writes. While some previous research has found longer median overall survival with hepatic resection - of more than five years in some cases - results have been mixed and no randomized trials have compared outcomes.

In the current retrospective analysis, no post-operative deaths and a low rate of complications were seen with hepatic resection.

One limitation of the study is that patients were not randomized to treatment, and were chosen for hepatic resection based on clinical considerations, the study team notes. The analysis also included patients treated over two decades, and changes to chemotherapy over time may have impacted the results.

"It is likely those who had surgery had less tumor burden in their body, that's why they were offered surgery," Dr. Obeid said.

It's also possible that in some patients with metastatic breast cancer, metastases in other areas of the body, but not the liver, respond to systemic treatment, Dr. Obeid said. In these cases, surgery could prove helpful.

"In general, most professional guidelines do not advocate for surgery for metastatic disease in breast cancer," said Dr. Anees Chagpar, a professor of surgery at Yale University School of Medicine in New Haven, Connecticut, who wasn't involved in the study.

"This study adds to the albeit scarce data from retrospective studies demonstrating that there may be a benefit from surgery in breast cancer patients with liver metastases, but these studies must be viewed in light of their limitations," Dr. Chagpar said by email.

"It is likely that there was some selection bias that went into the decision of which patients should have surgery vs which patients should not - and factors other than the surgery itself may have played a role in the survival difference that was seen," Dr. Chagpar added. "We do not have, based on this study, data on which patients would be better or worse candidates for surgical resection of their liver metastases, versus treatment with percutaneous ablation, chemoembolization, or systemic therapy alone."

SOURCE: https://bit.ly/3a4OJaz American Journal of Surgery, online February 28, 2020.