Management of patients with liver-confined, synchronous metastatic breast cancer
Introduction: Approximately 5 % of patients with new breast cancer diagnoses have stage IV disease and 10 % of these patients have liver-confined metastases. The surgical management of synchronous liver metastases remains controversial. Methods: The National Cancer Database was queried for patients presenting with liver-confined stage IV breast cancer between 2010 and 2018. The cohort was stratified by surgical management: no surgery [NS], primary breast tumor resection [BR], liver resection [LR], and primary breast tumor and liver resection [BR + LR]. The primary outcome was overall survival (OS). Additionally, a retrospective institutional review of patients who underwent surgical intervention and/or microwave ablation from 2013 - 2023 is presented. Results: In the NCDB, we identified 3747 patients: 2115 NS, 1458 BR, 22 LR, and 134 BR + LR. Median time to primary resection was 5.5 months (IQR 1.2 – 7.1). Median OS was 49.3 months (46.7 – 53.1). Patients receiving BR + LR had the highest unadjusted 5-year OS (68.9 %), followed by BR (52.4 %), NS (36.8 %), and LR (30.6 %). This association was preserved in an adjusted analysis for BR + LR (HR 0.34, 0.24 – 0.47; p < 0.01). The institutional cohort consisted of 8 patients with a median follow-up of 3.6 years who underwent BR + LR after a median of 16 cycles of chemotherapy, yielding 100 % OS. Conclusions: A minority of patients who present with liver-confined stage IV breast cancer will undergo any operation, though BR+LR was associated with improved survival. Hepatic metastasectomy may be considered in highly selected patients. Synopsis: Multivariable analysis of an NCDB cohort of 3747 patients presenting with de novo metastatic breast cancer confined to the liver between 2010–2018 demonstrates an association between improved overall survival and combined resection of both the primary breast tumor and hepatic metastases.
