predicting which patients will do best with surgery removing liver metastases

[Lani]

Surgery. 2012 Jan 27. [Epub ahead of print]
Resection of liver metastases from breast cancer: Estrogen receptor status and response to chemotherapy before metastasectomy define outcome.
Abbott DE, Brouquet A, Mittendorf EA, Andreou A, Meric-Bernstam F, Valero V, Green MC, Kuerer HM, Curley SA, Abdalla EK, Hunt KK, Vauthey JN.
Source
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND:
The oncologic benefit of resecting liver metastases in patients with breast cancer is unclear. This study was performed to identify predictors of survival after hepatectomy.
METHODS:
Between 1997 and 2010, 86 patients underwent resection of breast cancer liver metastases. Clinicopathologic characteristics of the primary breast neoplasm, timing of metastasis development, and treatment were recorded. Response to prehepatectomy chemotherapy was evaluated according to Response Criteria in Solid Tumors criteria, and the best response to chemotherapy during treatment and the response immediately before hepatectomy were noted. Univariate and multivariate analyses were performed to identify predictors of disease-free survival and overall survival.
RESULTS:
Fifty-nine patients (69%) had estrogen receptor- or progesterone receptor- positive primary breast neoplasms. Fifty-three patients (62%) had a solitary breast cancer liver metastasis, and 73 (85%) had breast cancer liver metastases ≤5 cm. Sixty-five patients (76%) received prehepatectomy hormonal and/or chemotherapy. Four patients (6%) had progressive disease as the best response, and 19 patients (30%) had progressive disease before hepatectomy (P < .001). Seventy percent of patients who received preoperative chemotherapy or hormonal therapy had either response or stable disease immediately before hepatectomy. No postoperative deaths were observed. At a 62-month median follow-up, the disease-free survival and overall survival were 14 and 57 months, respectively. On univariate analysis, estrogen receptor/progesterone receptor status of the primary breast neoplasm, best radiographic response, and preoperative radiographic response were associated with overall survival. On multivariate analysis, estrogen receptor-negative primary breast disease (P = .009; hazard ratio, 3.3; 95% confidence interval, 1.4-8.2) and preoperative progressive disease (P = .003; hazard ratio, 3.8; 95% confidence interval, 1.6-9.2) were associated with decreased overall survival.
CONCLUSION:
Resection of breast cancer liver metastases in patients with estrogen receptor-positive disease that is responding to chemotherapy is associated with improved survival. The timing of operative intervention may be critical; resection before progression is associated with a better outcome.
Copyright © 2012 Mosby, Inc. All rights reserved.
PMID: 22285778 [PubMed - as supplied by publisher]

[CoolBreeze]

I'm hoping for the 57 months!

[nsebesta]

one of the authors of the study is the doctor who performed my liver resection on Feb 1, 2005...7 years ago. Still NED, only on herceptin! Praise God!

[sarah]

cool breeze, confident you'll make it way past the 57 months.
hugs and love
sarah

[michka]

Thank you for posting Lani!
It is a small study conducted between 1997 and 2010 but encouraging. I would love a study for HER2s! It might be even better.Thank you also Nsebesta for posting. Your case gives us hope. Michka

[CoolBreeze]

Were you always only on herceptin, or did you do chemo?

I ask because after my resection, I was to go back on chemo but a c-diff infection has prevented it. I was so confident I'd do well, now I'm nervous as hell since I can't get the treatment I should have gotten. I just had a relapse of c-diff so this isn't going away any time soon.

[nsebesta]

After the surgery, yes. Only herceptin. Did taxol, carboplatin and herceptin until these lesions weren't visible on a CT scan - about 8 treatments and then had the surgery. I was worried at first too about not getting anymore chemo after surgery, but ev erything has been NED since!

[CoolBreeze]

Thanks Nsebesta! That comforts me a bit. Post-resection, I was going to continue to do chemo indefinitely but this infection has prevented that. I do, fortunately, get to continue herceptin so it's good to hear that NED is still attainable.

At my last scan, I was, indeed, NED. I have another scan coming up and I hope to hear the same thing.

[nsebesta]

cool breeze - you will!!! You've been through so much already!