Prognostic factors for survival in patients with breast cancer and liver metastases.

In patients with breast cancer (BC) the liver is one of the site of distant metastases, accounting for about 15% of patients. Isolated liver metastases (LMs) are uncommon, and the presence of extra-hepatic disease usually represents a contraindication to liver resection. Liver metastasis of BC origin is usually life limiting, and the patient needs treatment. Surgical resection of parts of the liver is considered the only potentially curative therapy, but unfortunately only few patients are suitable for liver resection. The 5-year survival of patients with LMs from colorectal cancer ranges from 20% to 25%, while the survival period after resection to manage LMs from BC is unclear, due to the limited number of studies, ranging between 36-42 months. The aims of this study was to identify factors predictive of survival of women with LMs from BC who underwent liver resection, and to evaluate possible relationship between survival, age, primitive tumor size, number of LM, CA 15-3, ER and PR rate. The medical charts of 11 women (median age 57 years, range 39-67 years) with LM and no evidence of extra-hepatic disease who had undergone curative surgery for BC were reviewed retrospectively. All patients received 6-12 cycles of neoadjuvant chemotherapy (anthracyclines) alone or chemotherapy plus hormone therapy (tamoxifen or aromatase inhibitors) prior to liver resection (wedge resection or segmentectomy), and those with disease progression were excluded. All LMs were metachronous, 7 patients had a single LM, 3 had two LMs, and 1 had three LMS. The baseline data were: size of the primitive BC=25.8±6.4 mm, number of LMs=1.4±0.68, ER=46.6±33.8%, PR=48.3±34.2%, CA15-3=84.7±33.1 U/mL. The median survival rate was 32 months (range 12-77 months). As expected, there was a significant correlation between ER and both PR (R=0.95, p< 0.001) and CA 15-3 (R=0.64, p=0.034), and between CA 15-3 and both PR (R=0.67, p=0.024) and number of LMs (R=0.69, p=0.017). At univariate analysis younger age, number of LMS, and size of the primitive tumor were associated with poorer prognosis, while at multivariate analysis only the age (R=0.81, p=0.002) of the patients was an independent factor of survival. In conclusion, the survival of patients with BC and LMs is independent of hormone-receptor status and serum CA 15-3 levels at the time of liver resection.