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Review
. 2022 Mar 26;14(7):1691.
doi: 10.3390/cancers14071691.

Prognostic Factors in Patients with Breast Cancer Liver Metastases Undergoing Liver Resection: Systematic Review and Meta-Analysis

Federica Galiandro  1 , Salvatore Agnes  1 , Giovanni Moschetta  1 , Armando Orlandi  2 , George Clarke  3 , Emilio Bria  2 , Gianluca Franceschini  4 , Giorgio Treglia  5   6   7 , Francesco Giovinazzo  1
Affiliations
Review

Prognostic Factors in Patients with Breast Cancer Liver Metastases Undergoing Liver Resection: Systematic Review and Meta-Analysis

Federica Galiandro et al. Cancers (Basel). .

Abstract

Background: The role of surgical resection of liver metastases in patients with breast cancer liver metastasis (BCLM) remains controversial. A systematic review and meta-analysis of prognostic factors related to survival after BCLM resection was performed.

Methods: An electronic search of relevant publications was performed. Pooled outcome measures were expressed as hazard ratios (HRs), including 95% confidence interval values (95% CIs), and calculated through a random-effects model. Heterogeneity was tested through the I2 index.

Results: Thirty-five publications reported analyses on prognostic factors and survival. A total of 2782 patients who underwent liver resection for BCLM were included. Positive axillary lymph nodes at breast cancer diagnosis were an unfavorable survival factor (HR 1.74, 95% CI 1.25 to 2.41, I2 = 0%). Cumulative predictive factor HRs (multiple liver metastases, size of the metastases, short interval between primary tumor and onset of liver disease) related to the BCLM pattern were 1.32 (95% CI 1.17 to 1.48, I2 = 71%) and 1.51 (95% CI 1.15 to 1.98, I2 = 76%) for surgical and pathological features (resection margin and presence of extrahepatic disease), respectively.

Conclusion: Resection of BCLM may provide a survival benefit for selected patients. For better long-term results, surgical selection should consider both primary tumor and BCLM features such as negative axillary lymph nodes at breast resection, a single hepatic lesion, a time longer than 24 months between breast and hepatic diagnosis, and a realizable R0 liver resection. However, the high heterogeneity among studies suggests the need for an RCT to validate the present findings.

Keywords: breast cancer; hepatic resection; liver metastases; meta-analysis; prognostic factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram with included studies.
Figure 2
Figure 2
Different forest plots for predictive factors related to the primary tumor: axillary nodes; age at breast cancer diagnosis; stage III/IV breast cancer.
Figure 3
Figure 3
Cumulative forest plot for predictive factors related to primary tumor receptor status.
Figure 4
Figure 4
Cumulative forest plot for predictive factors related to the BCLM pattern.
Figure 5
Figure 5
Cumulative forest plot for predictive factors related to time of presentation of the BCLM.
Figure 6
Figure 6
Cumulative forest plot for surgical and pathological features.
See this image and copyright information in PMC

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