| Objective(s):To compare the survival data of patients with breast cancer liver metastases taking different therapeutic patterns,analyze the value of local treatment in patients of breast cancer with liver metastases,and to discuss the prognostic factors of breast cancer liver metastases and the significance of biopsy of metastatic sites in clinical diagnosis and treatment.Methods:The patients with breast cancer liver metastases were retrospectively and analyzed,who were diagnosed and treated in our clinic during the period of April 2007 to October 2017.A total of 262 patients were included for analysis.All of them were divided into two groups,systemic treatment group(205 cases)and local treatment group(local treatment combined with systemic treatment,57 cases),according to whether to take local treatment in combination.The survival differences between the two groups were compared using Kaplan-Meier analyses,and further to explore the risk factors that influence long-term survival of patients after local treatment.There were 85 liver metastases patients meet the requirements for sub-analysis.Log-rank test was used to analyze the impact of various factors on survival(including age at diagnosis of breast cancer,T stage,N stage,treatment at primary lesions,the time of liver metastases occurred,the interval time between diagnosis of breast cancer and liver metastases,the number and the size of metastases).The variables,that shown statistical differences in univariate analysis,were involved in the multivariate Cox proportional hazard regression model for analysis,to figure out the factors influencing the long-term survival of patients independently.Fisher’s exact probability was used to compare the difference between the primary and the metastatic on the status of estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(HER-2),and further to discuss their clinical significance.Results:1.Survival analysis:the statistical difference on overall survival(OS)was found between the two treatment groups(P=0.002).Median survival of patients with local treatment was 19 months,compared with 11 months for patients receiving systemic therapy alone,the survival time of patients has been prolonged significantly by taking local treatment.The influence of the number of liver metastases on the long-term survival of patients with breast cancer liver metastases after local treatment had a statistically different(HR=1.637,95%CI:1.173-2.283,P=0.005).The results of subgroup analysis showed that there is an improvement on overall survival of breast cancer liver metastases who received liver lesion resection or radiofrequency ablation(RFA)combined with systemic treatment than that of receiving systemic treatment alone,and the difference was statistically significant(P<0.05).2.Analysis of related factors:the univariate survival analysis showed that the following factors were connected with the OS:surgical at primary lesions(χ2=8.433,P=0.004),chemotherapy at primary lesions(x2=5.609,P=0.018),radiotherapy at primary lesions(χ2=6.915,P=0.009),time when liver metastases occurs(χ2=13.614,P=0.001)and the metastasis of liver(x2=4.522,P=0.033).The results of Cox regression analysis showed that,time when liver metastases occurs(HR=0.625,95%CI:0.484-0.809,P<0.001)and the metastasis of liver(HR=1.902,95%CI:1.142-3.169,P=0.013)could influence the prognosis of breast cancer liver metastases individually.3.Pathological features of the metastases:the changes happened to the status of endocrine receptor and(HER-2)between the primary lesion and the liver metastases,and the inconsistency rates of ER,PR,and HER-2 were 27.78%,47.22%and 5.56%respectively.OS of the patients with these changes was not significantly different from that of patients without changes(P=0.198).Conclusion(s):For breast cancer liver metastases,systemic treatment combined with local treatments such as liver lesion resection or radiofrequency ablation and other local treatments may contribute to improve survival of the patients,while there is no survival benefit of vascular interventional local treatment.The degree of benefit of breast cancer liver metastases is relevant to the number of metastases and the time of liver metastases.The patients with less than 3 metastases had a better prognosis relatively;while the patients of breast cancer diagnosed with liver metastases at the first visit(stage Ⅳ)had a worse prognosis than those who were diagnosed with liver metastases after adjuvant therapy.There is a high proportion of inconsistencies on the status of receptor and HER-2 between the primary and the metastases of breast cancer.To clarify the molecular biological characteristics of liver metastases is essential for the clinical treatment of breast cancer liver metastases and is conducive to formulating more effective treatment strategies for the patients. |
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