Hepatic resection in metastatic breast cancer: results and prognostic factors

Aims: Breast cancer liver metastases (BCLM) usually indicate the presence o f disseminated cancer with a very poor prognosis. However, systemic treatme nts now allow control of tumour progression in certain cases. We evaluated, in a group of highly selected patients with stabilization or complete resp onse to systemic therapy, a particular management protocol for medically co ntrolled BCLM: 'adjuvant' liver surgery. Methods: Fifty-two patients underwent surgery between May 1988 and Septembe r 1997. Results of this strategy are reported, together with analysis of pr ognostic factors for survival and recurrence in the remaining liver (RRL). Results: The mean number of cycles of chemotherapy, before surgery, was sev en (3-24). Resection was considered to be curative in 86% of cases. The med ian follow-up was 23 months (1-72 months). The survival after surgery, was 86% at 12 months, 79% at 24 months and 49% at 36 months. The 36-month survi val rate differed according to the time to onset of BCLM: 45% before versus 82% after 48 months (P=0.023). The RRL rate at 36 months differed accordin g to the lymph node status of the initial breast cancer: 41% for NO-N1 vers us 83% for N1b-N2 (P=0.021). Conclusions: Adjuvant liver surgery allowed discontinuation of chemotherapy in 46% of cases and, in this highly selected patient group, allowed good q uality prolonged survival. It could be included in multicentre treatment pr otocols for controlled BCLM, one arm with prolonged chemotherapy, one with adjuvant liver surgery.