title: Liver resection in selected patients with metastatic breast cancer: a single-centre analysis and review of literature.
abstract: OBJECTIVE
  Despite the development of modern chemotherapeutics and target-specific drugs as well as improved surgical techniques, prognosis of metastatic breast cancer remains poor. Only a small number of selected patients will be eligible for liver resection and/or alternative metastatic ablation. Data on prognostic factors for patients with surgically resectable liver metastases of breast cancer are scarce at present.
  
  
  METHODS
  From 1997 to 2010, 50 patients with hepatic metastases of breast cancer have undergone laparotomy with the intention to undergo a curative liver resection at our institution. Data from these patients were collected in a prospectively maintained standardized liver resection data base.
  
  
  RESULTS
  Liver resection was performed in 34 patients. Resection margins were clear in 21 cases (R0). Nine patients lived for more than 60 months after liver resection. The observed 5-year survival rate was 21% for all 50 patients, 28% for resected patients and 38% after R0-resection. On univariate analysis, survival rates of the resected patients were statistically significantly influenced by R-classification, age, extrahepatic tumour at the time of liver resection, size of metastases and HER2 expression of liver metastases. Multivariate analysis revealed absence of HER2 expression, presence of extrahepatic tumour and patient's age ≥50 years as independent factors of poor prognosis.
  
  
  CONCLUSIONS
  Breast cancer patients younger than 50 years with technically resectable hepatic metastases, minimal extrahepatic tumour and positive HER2 expression appear to be suitable candidates for liver resection with curative intent. An aggressive multi-disciplinary management of those patients including surgical treatment may improve long-term survival.
authors: Department of General, Visceral und Vascular Surgery, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. yves.dittmar@med.uni-jena.de
authors: Y
authors: Y
authors: Dittmar
authors: A
authors: A
authors: Altendorf-Hofmann
authors: S
authors: S
authors: Schüle
authors: M
authors: M
authors: Ardelt
authors: O
authors: O
authors: Dirsch
authors: I B
authors: IB
authors: Runnebaum
authors: U
authors: U
authors: Settmacher
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D016016:Proportional Hazards Models
references: Onkologie. 2012;35 Suppl 1:28-33
references: 22286585
references: Breast Cancer Res Treat. 2006 Jun;97(3):237-44
references: 16322882
references: Eur J Surg Oncol. 2009 Nov;35(11):1146-51
references: 19398188
references: Breast Cancer Res Treat. 2011 Oct;129(3):659-74
references: 21698410
references: World J Gastroenterol. 2012 Jan 7;18(1):16-24
references: 22228966
references: Am J Surg. 2003 Feb;185(2):158-64
references: 12559448
references: Oncologist. 2003;8(3):241-51
references: 12773746
references: Ann Surg. 2006 Dec;244(6):897-907; discussion 907-8
references: 17122615
references: Breast Cancer. 2012 Jul;19(3):200-5
references: 21491123
references: J Gastrointest Surg. 2011 Mar;15(3):416-9
references: 21301986
references: HPB (Oxford). 2006;8(2):97-9
references: 18333254
references: Ann Surg Oncol. 2008 Jan;15(1):207-18
references: 17963007
references: Clin Oncol (R Coll Radiol). 2010 Nov;22(9):781-4
references: 20829004
references: Ann Surg Oncol. 2005 Oct;12(10):778-85
references: 16132374
references: Ann Surg Oncol. 2007 Dec;14(12):3345-51
references: 17687611
references: Eur J Cancer. 2011 Oct;47(15):2282-90
references: 21741832
references: Ann Surg Oncol. 2010 Jun;17(6):1546-54
references: 20143267
references: Am J Surg. 2006 Feb;191(2):281-3
references: 16442961
references: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references: 21296855
references: Eur J Surg Oncol. 2000 Mar;26(2):155-9
references: 10744935
references: J Surg Oncol. 2008 Jan 1;97(1):25-9
references: 18041746
references: Ann Oncol. 2008 Dec;19(12):2012-9
references: 18641006
references: Swiss Med Wkly. 2011 Jun 27;141:w13231
references: 21706452
references: Anticancer Res. 1998 May-Jun;18(3C):2231-3
references: 9703791
references: Eur J Cancer. 2011 Sep;47 Suppl 3:S6-22
references: 21944030
references: Ann Surg. 2008 May;247(5):732-8
references: 18438108
references: World J Surg. 2005 Apr;29(4):524-7
references: 15770377
references: Hepatogastroenterology. 2002 Nov-Dec;49(48):1597-601
references: 12397744
references: Breast Cancer Res Treat. 2012 Apr;132(2):511-21
references: 21667123
references: Minerva Chir. 2004 Feb;59(1):7-15
references: 15111827
references: Int J Colorectal Dis. 2011 Aug;26(8):967-81
references: 21584664
references: Ann Surg Oncol. 2004 Sep;11(9):869-74
references: 15342348