title: Liver metastases from breast cancer: Surgical resection or not? A case-matched control study in highly selected patients.
abstract: OBJECTIVE
  To determine whether, in a highly selected patient population, medical treatment combined with surgical resection of liver metastases from breast cancer is associated with improved survival compared with medical treatment alone.
  
  
  METHODS
  Between 1988 and 2007, 100 liver resections for metastatic breast cancer were performed at Institut Curie, 51 of which met the criteria for inclusion in this case-control study. With the exception of bone metastases, patients with other distant metastasis sites were excluded. Surgery was only performed in patients with stable disease or disease responding to medical treatment evaluated by imaging evaluation. Surgical cases were individually matched with 51 patients receiving medical treatment only. All patients had 4 or fewer resectable liver metastases. The study group was matched with the control group for age, year of breast cancer diagnosis, time to metastasis, TNM stage, hormone receptor status and breast cancer tumour pathology.
  
  
  RESULTS
  Univariate analysis confirmed a survival advantage for patients lacking bone metastases and axillary lymphadenopathy at the time of breast cancer diagnosis and for surgically treated patients. Multivariate analysis indicated that surgery and the absence of bone metastases were associated with a better prognosis. A multivariate Cox model adapted for paired data showed a RR = 3.04 (CI: 1.87-4.92) (p < 0.0001) in favour of surgical treatment.
  
  
  CONCLUSIONS
  Surgical resection of liver metastases from primary breast cancer appears to provide a survival benefit for highly selected patients.
authors.affiliation: Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex, France. Electronic address: pascale.mariani@curie.net.
authors.forename: P
authors.initials: P
authors.lastname: Mariani
authors.forename: V
authors.initials: V
authors.lastname: Servois
authors.forename: Y
authors.initials: Y
authors.lastname: De Rycke
authors.forename: S P
authors.initials: SP
authors.lastname: Bennett
authors.forename: J G
authors.initials: JG
authors.lastname: Feron
authors.forename: M M
authors.initials: MM
authors.lastname: Almubarak
authors.forename: F
authors.initials: F
authors.lastname: Reyal
authors.forename: B
authors.initials: B
authors.lastname: Baranger
authors.forename: J Y
authors.initials: JY
authors.lastname: Pierga
authors.forename: R J
authors.initials: RJ
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D016016:Proportional Hazards Models
keywords: Breast cancer; Liver metastases; Liver resection