Available online 1 November 2022
Highlights•Mortality rates were significantly reduced at 1-year in those who had surgery.
•Mortality rates were significantly reduced at 5-years in those who had surgery.
•Overall survival was significantly better among those who underwent surgery.
•Liver resection may be considered at multidisciplinary meetings for those with BCLM.
AbstractIntroductionThere is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM).
AimTo perform a systematic review and meta-analysis evaluating the role of liver resection for BCLM.
MethodsA systematic review was performed as per PRISMA guidelines. Hazard ratio (HR) for overall survival (OS) and standard error was obtained from each study and expressed using the generic inverse variance method, with a corresponding 95% confidence interval (CI). OS outcomes at 1- 3- and 5-years were expressed as dichotomous variables and pooled as odds ratios (OR) using the Mantel-Haenszel method.
ResultsNine studies with 1732 patients were included. Of these, 24.5% underwent surgical resection of BCLM (424/1732) and 75.5% did not (1308/1732). Overall, OS was significantly better among those who underwent surgery versus controls (HR: 0.69, 95% CI: 0.59–0.80, P < 0.00001). Mortality rates were significantly reduced at 1-year (7.5% (10/134) vs 20.3% (79/390), OR: 0.25, 95% CI: 0.08–0.74, P = 0.010) and 5-years (54.0% (190/352) vs 75.3% (940/1249), OR: 0.46, 95% CI: 0.25–0.87, P = 0.020) respectively for those undergoing surgery versus controls. Mortality rates at 3 years after surgery were lower than the control group (19.1% (29/152) vs 53.0% (222/419)), however this failed to achieve statistical significance at meta-analysis (OR: 0.32, 95% CI: 0.09–1.12, P = 0.070).
ConclusionLiver resection may be considered at multidisciplinary meetings for those with BCLM and offers a potentially curative option. However, judicious patient selection is crucial prior to making decisions in relation to resection of BCLM.
KeywordsBreast cancer
Liver metastases
Liver resection
Overall survival
Meta-analysis
AbbreviationsBCLMBreast cancer with liver metastases
ESMOEuropean Society for Medical Oncology
NCCNNational Comprehensive Cancer Network
PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses
SPSSStatistical Package for Social Sciences
© 2022 The Author(s). Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
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