Background. Breast cancer liver metastasis is a hematogenous spread of the primary tumour. It can, however, be the expression of an isolated recurrence. Surgical resection is often possible but controversial. Methods. We report on 29 female patients treated operatively due to isolated breast cancer liver metastasis over a period of six years. Prior to surgery all metastases appeared resectable. Liver metastasis had been diagnosed 55 (median, range 1–177) months after primary surgery. Results. Complete resection of the metastases was performed in 21 cases. The intraoperative staging did not confirm the preoperative radiological findings in 14 cases, which did not generally lead to inoperability. One-year survival rate was 86% in resected patients and 37.5% in nonresected patients. Significant prognostic factors were R0 resection, low T- and N-stages as well as a low-grade histopathology of the primary tumour, lower number of liver metastases, and a longer time interval between primary surgery and the occurrence of liver metastasis. Conclusions. Complete resection of metastases was possible in three-quarters of the patients. Some of the studied factors showed a prognostic value and therefore might influence indication for resection in the future. 1. Introduction Metastasis is the most common cause of death in cancer patients [1]. Breast cancer might spread via blood stream and cause liver metastasis. This can arise simultaneously or decades after the primary tumour. Metastases are often the sole sign of recurrence of the breast cancer. References show that 2–12% of patients with breast cancer have liver metastasis [2, 3], which, however, might be isolated in some cases. In patients with resectable colorectal liver metastasis, surgical resection is the only curative approach, if an additional nonresectable extrahepatic tumour is excluded. References report 5-year survival rates of 30 to 47% in these patients [4–7]. Surgical management is therefore recommended in the German S3-guidelines for colorectal cancer [8]. In contrast to this the data on isolated liver metastasis in breast cancer patients is not as explicit. After the release of the initial study on resection of noncolorectal nonneuroendocrine liver metastases [9], innumerous similar studies followed [10–15]. The large range of tumour entities including patients with breast cancer is the common denominator of these studies. Breast cancer, however, represents only a minor share in the tumours examined and is stated to have a comparably good prognosis [10, 12–15]. The survival rates are reported to be
References
[1]
A. Jemal, R. Siegel, E. Ward, T. Murray, J. Xu, and M. J. Thun, “Cancer statistics, 2007,” Ca-A Cancer Journal for Clinicians, vol. 57, no. 1, pp. 43–66, 2007.
[2]
E. Viadana, I. D. Bross, and J. W. Pickren, “An autopsy study of some routes of dissemination of cancer of the breast,” British Journal of Cancer, vol. 27, no. 4, pp. 336–340, 1973.
[3]
Y. T. N. Lee, “Breast carcinoma: pattern of metastasis at autopsy,” Journal of Surgical Oncology, vol. 23, no. 3, pp. 175–180, 1983.
[4]
A. Sj?vall, V. J?rv, L. Blomqvist et al., “The potential for improved outcome in patients with hepatic metastases from colon cancer: a population-based study,” European Journal of Surgical Oncology, vol. 30, no. 8, pp. 834–841, 2004.
[5]
J. Leporrier, J. Maurel, L. Chiche, S. Bara, P. Segol, and G. Launoy, “A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer,” British Journal of Surgery, vol. 93, no. 4, pp. 465–474, 2006.
[6]
P. C. Simmonds, J. N. Primrose, J. L. Colquitt, O. J. Garden, G. J. Poston, and M. Rees, “Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies,” British Journal of Cancer, vol. 94, no. 7, pp. 982–999, 2006.
[7]
A. C. Wei, P. D. Greig, D. Grant, B. Taylor, B. Langer, and S. Gallinger, “Survival after hepatic resection for colorectal metastases: a 10-year experience,” Annals of Surgical Oncology, vol. 13, no. 5, pp. 668–676, 2006.
[8]
C. Pox, S. Aretz, S. C. Bischoff, U. Graeven, M. Hass, and P. Heu?ner, “S3-guideline colorectal cancer version 1.0,” Zeitschrift für Gastroenterologie, vol. 51, pp. 753–854, 2013.
[9]
L. E. Harrison, M. F. Brennan, E. Newman et al., “Hepatic resection for noncolorectal, nonneuroendocrine metastases: a fifteen-year experience with ninety-six patients,” Surgery, vol. 121, no. 6, pp. 625–632, 1997.
[10]
G. Ercolani, G. L. Grazi, M. Ravaioli et al., “The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases,” Annals of Surgical Oncology, vol. 12, no. 6, pp. 459–466, 2005.
[11]
J. Weitz, L. H. Blumgart, Y. Fong et al., “Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma,” Annals of Surgery, vol. 241, no. 2, pp. 269–276, 2005.
[12]
R. Adam, L. Chiche, T. Aloia et al., “Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1452 patients and development of a prognostic model,” Annals of Surgery, vol. 244, no. 4, pp. 524–533, 2006.
[13]
M. S. Metcalfe, E. J. Mullin, and G. J. Maddern, “Hepatectomy for metastatic noncolorectal gastrointestinal, breast and testicular tumours,” ANZ Journal of Surgery, vol. 76, no. 4, pp. 246–250, 2006.
[14]
J. Lendoire, M. Moro, O. Andriani et al., “Liver resection for non-colorectal, non-neuroendocrine metastases: analysis of a multicenter study from Argentina,” HPB, vol. 9, no. 6, pp. 435–439, 2007.
[15]
S. K. Reddy, A. S. Barbas, C. E. Marroquin, M. A. Morse, P. C. Kuo, and B. M. Clary, “Resection of noncolorectal nonneuroendocrine liver metastases: a comparative analysis,” Journal of the American College of Surgeons, vol. 204, no. 3, pp. 372–382, 2007.
[16]
D. Elias, P. H. Lasser, D. Montrucolli, S. Bonvallot, and M. Spielmann, “Hepatectomy for liver metastases from breast cancer,” European Journal of Surgical Oncology, vol. 21, no. 5, pp. 510–513, 1995.
[17]
R. Raab, K.-T. Nussbaum, M. Behrend, and A. Weimann, “Liver metastases of breast cancer: results of liver resection,” Anticancer Research, vol. 18, no. 3, pp. 2231–2233, 1998.
[18]
S. Kondo, H. Katoh, M. Omi et al., “Hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer,” Hepato-Gastroenterology, vol. 47, no. 36, pp. 1501–1503, 2000.
[19]
S.-M. Maksan, T. Lehnert, G. Bastert, and C. Herfarth, “Curative liver resection for metastatic breast cancer,” European Journal of Surgical Oncology, vol. 26, no. 3, pp. 209–212, 2000.
[20]
M. Pocard, P. Pouillart, B. Asselain, and R.-J. Salmon, “Hepatic resection in metastatic breast cancer: results and prognostic factors,” European Journal of Surgical Oncology, vol. 26, no. 2, pp. 155–159, 2000.
[21]
M. Selzner, M. A. Morse, J. J. Vredenburgh, W. C. Meyers, and P.-A. Clavien, “Liver metastases from breast cancer: long-term survival after curative resection,” Surgery, vol. 127, no. 4, pp. 383–389, 2000.
[22]
M. Carlini, M. T. Lonardo, F. Carboni et al., “Liver metastases from breast cancer. Results of surgical resection,” Hepato-Gastroenterology, vol. 49, no. 48, pp. 1597–1601, 2002.
[23]
D. Elias, F. Maisonnette, M. Druet-Cabanac et al., “An attempt to clarify indications for hepatectomy for liver metastases from breast cancer,” American Journal of Surgery, vol. 185, no. 2, pp. 158–164, 2003.
[24]
G. Vlastos, D. L. Smith, S. E. Singletary et al., “Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases,” Annals of Surgical Oncology, vol. 11, no. 9, pp. 869–874, 2004.
[25]
Y. Sakamoto, J. Yamamoto, M. Yoshimoto et al., “Hepatic resection for metastatic breast cancer: prognostic analysis of 34 patients,” World Journal of Surgery, vol. 29, no. 4, pp. 524–527, 2005.
[26]
R. Adam, T. Aloia, J. Krissat et al., “Is liver resection justified for patients with hepatic metastases from breast cancer?” Annals of Surgery, vol. 244, no. 6, pp. 897–907, 2006.
[27]
S. R. Martinez, S. E. Young, A. E. Giuliano, and A. J. Bilchik, “The utility of estrogen receptor, progesterone receptor, and Her-2/neu status to predict survival in patients undergoing hepatic resection for breast cancer metastases,” American Journal of Surgery, vol. 191, no. 2, pp. 281–283, 2006.
[28]
M. Caralt, I. Bilbao, J. Cortés et al., “Hepatic resection for liver metastases as part of the “oncosurgical” treatment of metastatic breast cancer,” Annals of Surgical Oncology, vol. 15, no. 10, pp. 2804–2810, 2008.
[29]
J. Lubrano, H. Roman, S. Tarrab, B. Resch, L. Marpeau, and M. Scotté, “Liver resection for breast cancer metastasis: does it improve survival?” Surgery Today, vol. 38, no. 4, pp. 293–299, 2008.
[30]
A. Thelen, C. Benckert, S. Jonas et al., “Liver resection for metastases from breast cancer,” Journal of Surgical Oncology, vol. 97, no. 1, pp. 25–29, 2008.
[31]
O. Kollmar, M. R. Moussavian, S. Richter, M. Bolli, and M. K. Schilling, “Surgery of liver metastasis in gynecological cancer—indication and results,” Onkologie, vol. 31, no. 7, pp. 375–379, 2008.
[32]
M. A. Cassera, C. W. Hammill, M. B. Ujiki, R. F. Wolf, L. L. Swanstr?m, and P. D. Hansen, “Surgical management of breast cancer liver metastases,” HPB, vol. 13, no. 4, pp. 272–276, 2011.
[33]
D. V. Kostov, G. L. Kobakov, and D. V. Yankov, “Prognostic factors related to surgical outcome of liver metastases of breast cancer,” Journal of Breast Cancer, vol. 16, pp. 184–192, 2013.
[34]
G. A. M. van Walsum, J. A. M. de Ridder, C. Verhoef, K. Bosscha, T. M. van Gulik, and E. J. Hesselink, “Resection of liver metastases in patients with breast cancer: survival and prognostic factors,” European Journal of Surgical Oncology, vol. 38, pp. 910–917, 2012.
[35]
Y. Fong, J. Fortner, R. L. Sun, M. F. Brennan, and L. H. Blumgart, “Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases,” Annals of Surgery, vol. 230, no. 3, pp. 309–321, 1999.
[36]
K. Hoffmann, C. Franz, U. Hinz et al., “Liver resection for multimodal treatment of breast cancer metastases: identification of prognostic factors,” Annals of Surgical Oncology, vol. 17, no. 6, pp. 1546–1554, 2010.
[37]
D. E. Abbott, A. Brouquet, E. A. Mittendorf et al., “Resection of liver metastases from breast cancer: estrogen receptor status and response to chemotherapy before metastasectomy define outcome,” Surgery, vol. 151, no. 5, pp. 710–716, 2012.
[38]
S. Rodes Brown and R. C. Martin, “Management of liver dominant metastatic breast cancer: surgery, chemotherapy, or hepatic arterial therapy—benefits and limitations,” Minerva Chirurgica, vol. 67, pp. 297–308, 2012.
[39]
R. Largillier, J.-M. Ferrero, J. Doyen et al., “Prognostic factors in 1038 women with metastatic breast cancer,” Annals of Oncology, vol. 19, no. 12, pp. 2012–2019, 2008.
[40]
X. F. Duan, N. N. Dong, T. Zhang, and Q. Li, “The prognostic analysis of clinical breast cancer subtypes among patients with liver metastases from breast cancer,” International Journal of Clinical Oncology, vol. 18, pp. 26–32, 2013.
[41]
J. Willner, I. C. Kiricuta, and O. K?lbl, “Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis,” International Journal of Radiation Oncology Biology Physics, vol. 37, no. 4, pp. 853–863, 1997.
[42]
L. D. C. Hoefnagel, M. J. van de Vijver, H.-J. van Slooten et al., “Receptor conversion in distant breast cancer metastases,” Breast Cancer Research, vol. 12, no. 5, article R75, 2010.
[43]
J. S. Koo, W. Jung, and J. Jeong, “Metastatic breast cancer shows different immunohistochemical phenotype according to metastatic site,” Tumori, vol. 96, no. 3, pp. 424–432, 2010.
[44]
N. Cabioglu, A. A. Sahin, P. Morandi et al., “Chemokine receptors in advanced breast cancer: differential expression in metastatic disease sites with diagnostic and therapeutic implications,” Annals of Oncology, vol. 20, no. 6, pp. 1013–1019, 2009.
[45]
H. Sihto, J. Lundin, M. Lundin et al., “Breast cancer biological subtypes and protein expression predict for the preferential distant metastasis sites: a nationwide cohort study,” Breast Cancer Research, vol. 13, no. 5, article no. R87, 2011.
[46]
X. F. Duan, N. N. Dong, T. Zhang, and Q. Li, “Treatment outcome of patients with liver-only metastases from breast cancer after mastectomy: a retrospective analysis,” Journal of Cancer Research and Clinical Oncology, vol. 137, no. 9, pp. 1363–1370, 2011.
[47]
X.-P. Li, Z.-Q. Meng, W.-J. Guo, and J. Li, “Treatment for liver metastases from breast cancer: results and prognostic factors,” World Journal of Gastroenterology, vol. 11, no. 24, pp. 3782–3787, 2005.
[48]
C. T. Sofocleous, R. G. Nascimento, M. Gonen et al., “Radiofrequency ablation in the management of liver metastases from breast cancer,” American Journal of Roentgenology, vol. 189, no. 4, pp. 883–889, 2007.
[49]
P. D. Beitsch and E. Clifford, “Detection of carcinoma cells in the blood of breast cancer patients,” American Journal of Surgery, vol. 180, no. 6, pp. 446–449, 2000.