Surgical resection versus systemic therapy for breast cancer liver metastases: Results of a European case matched comparison

A. Ruiz (Corresponding Author), R. van Hillegersberg, S. Siesling, C. Castro-Benitez, M. Sebagh, D. A. Wicherts, K. M. de Ligt, L. Goense, S. Giacchetti, D. Castaing, J. Morère, R. Adam

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Abstract

Background: Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted but not offered as therapeutic option. New evidence of the additional value of surgery in these patients is scarce while prognoses without surgery remains poor.

Patients and methods: For this case matched analysis, all nationally registered patients with BCLM confined to the liver in the Netherlands (systemic group; N = 523) were selected and compared with patients who received systemic treatment and underwent hepatectomy (resection group; N = 139) at a hepatobiliary centre in France. Matching was based on age, decade when diagnosed, interval to metastases, maximum metastases size, single or multiple tumours, chemotherapy, hormonal or targeted therapy after diagnosis. Based on published guidelines, palliative systemic treatment strategies are similar in both European countries.

Results: Between 1983 and 2013, 3894 patients were screened for inclusion. Overall median follow-up was 80 months (95% CI 70–90 months). The median, 3- and 5-year overall survival of the whole population was 19 months, 29% and 19%, respectively. The resection and systemic group had median survival of 73 vs. 13 months (P < 0.001), respectively. Three and 5-year survival was 18% and 10% for the systemic group and 75% and 54% for the resection group, respectively. After matching, the resection group had a median overall survival of 82 months with a 3- and 5-year overall survival of 81% and 69%, respectively, compared with a median overall survival of 31 months in the systemic group with a 3- and 5-year overall survival of 32% and 24%, respectively (HR 0.28, 95% CI 0.15–0.52; P < 0.001).

Conclusions: For patients with BCLM, liver resection combined with systemic treatment results in improved overall survival compared to systemic treatment alone. Liver resection should be considered in selected cases.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalEuropean journal of cancer
Volume95
DOIs
Publication statusPublished - 1 May 2018
Externally publishedYes

Fingerprint

Liver Neoplasms
Breast Neoplasms
Neoplasm Metastasis
Survival
Therapeutics
Liver
Hepatectomy
Palliative Care
Netherlands
France
Guidelines
Drug Therapy
Population
Neoplasms

Keywords

  • Breast
  • Cancer
  • Hepatectomy
  • Liver
  • Matched comparison
  • Metastases
  • Resection
  • Hybrid deal

Cite this

Ruiz, A. ; van Hillegersberg, R. ; Siesling, S. ; Castro-Benitez, C. ; Sebagh, M. ; Wicherts, D. A. ; de Ligt, K. M. ; Goense, L. ; Giacchetti, S. ; Castaing, D. ; Morère, J. ; Adam, R. / Surgical resection versus systemic therapy for breast cancer liver metastases : Results of a European case matched comparison. In: European journal of cancer. 2018 ; Vol. 95. pp. 1-10.
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title = "Surgical resection versus systemic therapy for breast cancer liver metastases: Results of a European case matched comparison",
abstract = "Background: Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted but not offered as therapeutic option. New evidence of the additional value of surgery in these patients is scarce while prognoses without surgery remains poor.Patients and methods: For this case matched analysis, all nationally registered patients with BCLM confined to the liver in the Netherlands (systemic group; N = 523) were selected and compared with patients who received systemic treatment and underwent hepatectomy (resection group; N = 139) at a hepatobiliary centre in France. Matching was based on age, decade when diagnosed, interval to metastases, maximum metastases size, single or multiple tumours, chemotherapy, hormonal or targeted therapy after diagnosis. Based on published guidelines, palliative systemic treatment strategies are similar in both European countries.Results: Between 1983 and 2013, 3894 patients were screened for inclusion. Overall median follow-up was 80 months (95{\%} CI 70–90 months). The median, 3- and 5-year overall survival of the whole population was 19 months, 29{\%} and 19{\%}, respectively. The resection and systemic group had median survival of 73 vs. 13 months (P < 0.001), respectively. Three and 5-year survival was 18{\%} and 10{\%} for the systemic group and 75{\%} and 54{\%} for the resection group, respectively. After matching, the resection group had a median overall survival of 82 months with a 3- and 5-year overall survival of 81{\%} and 69{\%}, respectively, compared with a median overall survival of 31 months in the systemic group with a 3- and 5-year overall survival of 32{\%} and 24{\%}, respectively (HR 0.28, 95{\%} CI 0.15–0.52; P < 0.001).Conclusions: For patients with BCLM, liver resection combined with systemic treatment results in improved overall survival compared to systemic treatment alone. Liver resection should be considered in selected cases.",
keywords = "Breast, Cancer, Hepatectomy, Liver, Matched comparison, Metastases, Resection, Hybrid deal",
author = "A. Ruiz and {van Hillegersberg}, R. and S. Siesling and C. Castro-Benitez and M. Sebagh and Wicherts, {D. A.} and {de Ligt}, {K. M.} and L. Goense and S. Giacchetti and D. Castaing and J. Mor{\`e}re and R. Adam",
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Ruiz, A, van Hillegersberg, R, Siesling, S, Castro-Benitez, C, Sebagh, M, Wicherts, DA, de Ligt, KM, Goense, L, Giacchetti, S, Castaing, D, Morère, J & Adam, R 2018, 'Surgical resection versus systemic therapy for breast cancer liver metastases: Results of a European case matched comparison' European journal of cancer, vol. 95, pp. 1-10. https://doi.org/10.1016/j.ejca.2018.02.024

Surgical resection versus systemic therapy for breast cancer liver metastases : Results of a European case matched comparison. / Ruiz, A. (Corresponding Author); van Hillegersberg, R.; Siesling, S.; Castro-Benitez, C.; Sebagh, M.; Wicherts, D. A.; de Ligt, K. M.; Goense, L.; Giacchetti, S.; Castaing, D.; Morère, J.; Adam, R.

In: European journal of cancer, Vol. 95, 01.05.2018, p. 1-10.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Surgical resection versus systemic therapy for breast cancer liver metastases

T2 - Results of a European case matched comparison

AU - Ruiz, A.

AU - van Hillegersberg, R.

AU - Siesling, S.

AU - Castro-Benitez, C.

AU - Sebagh, M.

AU - Wicherts, D. A.

AU - de Ligt, K. M.

AU - Goense, L.

AU - Giacchetti, S.

AU - Castaing, D.

AU - Morère, J.

AU - Adam, R.

N1 - Elsevier deal

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted but not offered as therapeutic option. New evidence of the additional value of surgery in these patients is scarce while prognoses without surgery remains poor.Patients and methods: For this case matched analysis, all nationally registered patients with BCLM confined to the liver in the Netherlands (systemic group; N = 523) were selected and compared with patients who received systemic treatment and underwent hepatectomy (resection group; N = 139) at a hepatobiliary centre in France. Matching was based on age, decade when diagnosed, interval to metastases, maximum metastases size, single or multiple tumours, chemotherapy, hormonal or targeted therapy after diagnosis. Based on published guidelines, palliative systemic treatment strategies are similar in both European countries.Results: Between 1983 and 2013, 3894 patients were screened for inclusion. Overall median follow-up was 80 months (95% CI 70–90 months). The median, 3- and 5-year overall survival of the whole population was 19 months, 29% and 19%, respectively. The resection and systemic group had median survival of 73 vs. 13 months (P < 0.001), respectively. Three and 5-year survival was 18% and 10% for the systemic group and 75% and 54% for the resection group, respectively. After matching, the resection group had a median overall survival of 82 months with a 3- and 5-year overall survival of 81% and 69%, respectively, compared with a median overall survival of 31 months in the systemic group with a 3- and 5-year overall survival of 32% and 24%, respectively (HR 0.28, 95% CI 0.15–0.52; P < 0.001).Conclusions: For patients with BCLM, liver resection combined with systemic treatment results in improved overall survival compared to systemic treatment alone. Liver resection should be considered in selected cases.

AB - Background: Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted but not offered as therapeutic option. New evidence of the additional value of surgery in these patients is scarce while prognoses without surgery remains poor.Patients and methods: For this case matched analysis, all nationally registered patients with BCLM confined to the liver in the Netherlands (systemic group; N = 523) were selected and compared with patients who received systemic treatment and underwent hepatectomy (resection group; N = 139) at a hepatobiliary centre in France. Matching was based on age, decade when diagnosed, interval to metastases, maximum metastases size, single or multiple tumours, chemotherapy, hormonal or targeted therapy after diagnosis. Based on published guidelines, palliative systemic treatment strategies are similar in both European countries.Results: Between 1983 and 2013, 3894 patients were screened for inclusion. Overall median follow-up was 80 months (95% CI 70–90 months). The median, 3- and 5-year overall survival of the whole population was 19 months, 29% and 19%, respectively. The resection and systemic group had median survival of 73 vs. 13 months (P < 0.001), respectively. Three and 5-year survival was 18% and 10% for the systemic group and 75% and 54% for the resection group, respectively. After matching, the resection group had a median overall survival of 82 months with a 3- and 5-year overall survival of 81% and 69%, respectively, compared with a median overall survival of 31 months in the systemic group with a 3- and 5-year overall survival of 32% and 24%, respectively (HR 0.28, 95% CI 0.15–0.52; P < 0.001).Conclusions: For patients with BCLM, liver resection combined with systemic treatment results in improved overall survival compared to systemic treatment alone. Liver resection should be considered in selected cases.

KW - Breast

KW - Cancer

KW - Hepatectomy

KW - Liver

KW - Matched comparison

KW - Metastases

KW - Resection

KW - Hybrid deal

U2 - 10.1016/j.ejca.2018.02.024

DO - 10.1016/j.ejca.2018.02.024

M3 - Article

VL - 95

SP - 1

EP - 10

JO - European journal of cancer

JF - European journal of cancer

SN - 0959-8049

ER -