Brief report
The utility of estrogen receptor, progesterone receptor, and Her-2/neu status to predict survival in patients undergoing hepatic resection for breast cancer metastases

https://doi.org/10.1016/j.amjsurg.2005.08.030Get rights and content

Abstract

Background

Hepatic metastases from breast cancer signal a dismal prognosis, with a median survival of 9.5 months.

Methods

Twenty breast cancer patients with liver metastases underwent hepatic resection, biopsy, or ablation between 1995 and 2004. Hormone receptor status and Her-2/neu expression of primary and metastatic tumors were correlated with overall survival.

Results

At a mean follow-up of 39 months after hepatic resection, median survival was 32 months. Patients undergoing anatomic resection with or without ablation lived significantly longer than those undergoing more limited resections (46 vs. 25 months, P = .016). Survival was significantly greater in patients with estrogen receptor (ER)–positive primary (P = .02) and metastatic (P < .004) tumors, Her-2/neu–positive metastases (P = .02), ≤2 hepatic metastases (P < .002), and age >50 years at metastasectomy (P = .02).

Conclusions

The ER status of the primary tumor and ER and Her-2/neu status of hepatic metastases, in addition to other clinical factors, may help select patients who would benefit from hepatic metastasectomy.

Section snippets

Methods

Between 1995 and 2004, 1147 liver-directed procedures were performed for primary or hepatic malignancies; 20 patients underwent hepatic resection, biopsy, or ablation for breast cancer metastases. The Saint John’s Health Center/John Wayne Cancer Institute Institutional Review Board granted human subject approval for a retrospective review of these patients. Variables measured were patient age at diagnosis of hepatic metastasis; tumor size and histology; axillary nodes affected; ER and PR status

Results

Patient and tumor characteristics are listed in Table 1. The mean follow-up after hepatic resection was 39 months. Median survival was 32 months; 2- and 5-year survival rates were 61% and 33%, respectively.

From the time of initial breast cancer diagnosis, survival was significantly greater in patients with ER-positive (9.58 vs. 7.60 years, P < .04) and PR-positive (11 vs. 7.18 years, P < .008) primary tumors, whereas the Her-2/neu status of the primary tumor did not reach statistical

Comments

Once breast cancer progresses to involve distant sites, survival is poor. The median survival for patients with hepatic metastases ranges from 1 to 25.3 months with palliative hormonal or chemotherapeutic treatment and supportive care [3], [4], [5], [6], [7], [8], [9]. A subset of patients, however, may benefit from resection even at this late stage. This assertion is supported by 5-year survival rates of 22% and median survival rates >30 months after resection of isolated breast hepatic

Acknowledgments

Supported by the Rod Fasone Memorial Cancer Fund (Indianapolis, IN); the Henry L. Guenther Foundation (Los Angeles, CA); the William Randolph Hearst Foundation (San Francisco, CA); the family of Jeanne and Eric Li and the Davidow Charitable Fund (Los Angeles, CA); the Ben B. and Joyce E. Eisenberg Foundation (Los Angeles, CA); the Fashion Footwear Association of New York Charitable Foundation (New York, NY); the Leslie and Susan Gonda (Goldschmied) Foundation (Los Angeles, CA); the John Wayne

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