title: Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results.
abstract: BACKGROUND
  Breast cancer liver metastases (BCLM) are considered the most lethal compared with other sites of metastases in patients with breast cancer. This study aimed to evaluate the outcome after hepatectomy for BCLM within current multidisciplinary treatment and to develop a clinically useful nomogram to predict survival.
  
  
  METHODS
  Between January 1985 and December 2012, 139 consecutive female patients underwent liver resection for BCLM at the authors' institution. Clinicopathologic data were collected and analyzed for survival outcome with determination of prognostic factors. A nomogram to predict survival was developed based on a multivariate Cox model. The predictive performance of the model was assessed according to the C-statistic and calibration plots.
  
  
  RESULTS
  After a median follow-up period of 55 months, the overall 3- and 5-year survival rates after hepatectomy were respectively 58 and 47 %. The median overall survival period was 56 months, and the median disease-free survival period after surgical resection was 33 months. A single hepatic metastasis, no triple negative tumors, no microscopic vascular invasion, and perioperative hormonal or targeted therapy were related to improved overall survival. The model achieved good discrimination and calibration, with a C-statistic of 0.80.
  
  
  CONCLUSIONS
  Liver resection for selected patients with breast cancer metastases can provide significant survival benefit. It should be part of a multidisciplinary treatment program in experienced liver surgery centers. The authors' nomogram facilitates personalized assessment of prognosis for these patients.
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Aldrick
authors: A
authors: Ruiz
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: Dennis A
authors: DA
authors: Wicherts
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors: Mylène
authors: M
authors: Sebagh
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France.
authors: Sylvie
authors: S
authors: Giacchetti
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Department of Surgery, Hospital Mexico, San José, Costa Rica.
authors: Carlos
authors: C
authors: Castro-Benitez
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Richard
authors: R
authors: van Hillegersberg
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.
authors: Bernard
authors: B
authors: Paule
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.|Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France.
authors: Denis
authors: D
authors: Castaing
authors: Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.|Université Paris-Sud, UMR-S 785, 94804, Villejuif, France.
authors: Jean-François
authors: JF
authors: Morère
authors: Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. rene.adam@pbr.aphp.fr.|Université Paris-Sud, UMR-S 785, 94804, Villejuif, France. rene.adam@pbr.aphp.fr.
authors: René
authors: R
authors: Adam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D044584:Carcinoma, Ductal / Q000556:secondary* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D049451:Nomograms; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate