手术对于乳腺癌肝转移的作用仍然存在争议。
3月28日，欧洲肿瘤外科学会《欧洲肿瘤外科杂志》在线发表美国德克萨斯大学MD安德森癌症中心、俄亥俄州立大学的单中心回顾研究报告，比较了乳腺癌肝转移全身治疗±肝切除术患者的生存结局，并确定了指导手术治疗的选择因素。
该单中心回顾研究对德克萨斯大学MD安德森癌症中心1997年4月～12月进行全身治疗＋肝切除术136例与仅仅全身治疗763例乳腺癌孤立型肝转移患者进行回顾分析。通过倾向评分匹配，对不同分子亚型乳腺癌的总生存进行分析。分子亚型包括：
管腔A型（雌激素受体和/或孕激素受体阳性、HER2阴性）
管腔B型（雌激素受体和/或孕激素受体阳性、HER2阳性）
HER2过表达型（雌激素受体和孕激素受体阴性，HER2阳性）
基底样型（雌激素受体、孕激素受体、HER2三阴性）
结果，肝切除术后总生存结局的独立预测因素包括：
肝转移数量（风险比：1.11）
肝转移大小（风险比：1.16）
分子亚型（风险比：4.28）
中位总生存（P<0.001）
HER2过表达型：81个月
管腔B型：75个月
管腔A型：53个月
基底样型：17个月
中位无进展生存（P<0.001）
HER2过表达型：60个月
管腔A型：17个月
管腔B型：16个月
基底样型：5个月
经过倾向评分匹配，手术组、仅仅全身治疗组的5年总生存率分别为56%、40%（P=0.018）。
因此，该研究结果表明，手术切除乳腺癌肝转移与仅仅全身治疗相比，总生存率较高，HER2阳性乳腺癌患者的无进展生存较长，有助于根据乳腺癌分子亚型合理选择患者进行手术治疗。
相关链接
乳腺癌肝转移：外科手术？内科治疗？
乳腺癌肝转移肝切除结局影响因素进展
乳腺癌肝转移分子机制及治疗潜在靶点
中国乳腺癌肝转移切除多中心分析
乳腺癌肝转移的奥沙利铂全身化疗或肝动脉化疗＋卡培他滨口服化疗
中国学者对乳腺癌肝转移经动脉化学栓塞进行系统回顾
乳腺癌肝转移研究进展
乳腺癌肝转移机制研究进展
Eur J Surg Oncol. Mar 28. [Epub ahead of print]
Hepatic resection for breast cancer liver metastases: Impact of intrinsic subtypes.
Yun Shin Chun, Takashi Mizuno, Jordan M. Cloyd, Min Jin Ha, Kiyohiko Omichi, Ching-Wei D. Tzeng, Thomas A. Aloia, Naoto T. Ueno, Henry M. Kuerer, Carlos H. Barcenas, Jean-Nicolas Vauthey.
The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Ohio State University, Columbus, OH, USA.
INTRODUCTION: The role of surgery for breast cancer liver metastases (BCLM) remains controversial. This study aimed to analyze survival in patients treated with hepatectomy plus systemic therapy or systemic therapy alone for BCLM and to determine selection factors to guide surgical therapy.
MATERIALS AND METHODS: Patients who underwent hepatectomy plus systemic therapy (n = 136) and systemic therapy alone for isolated BCLM (n = 763) were compared. Overall survival (OS) was analyzed after propensity score matching. Intrinsic subtypes were defined as: luminal A (estrogen receptor [ER]+ and/or progesterone receptor positive [PR]+, human epidermal growth factor receptor 2 [HER2]-), luminal B (ER and/or PR+, HER2+), HER2-enriched (ER and PR-, HER2+), and basal-like (ER, PR, HER2-).
RESULTS: After hepatectomy, independent predictors of poor OS were number and size of liver metastases, and intrinsic subtype (hazard ratios, 1.11, 1.16, and 4.28, respectively). Median OS was 75 and 81 months among patients with luminal B and HER2-enriched subtypes, compared with 17 and 53 months among patients with basal-like and luminal A subtypes (P<0.001). Median progression-free survival (PFS) was 60 months with the HER2-enriched subtype, compared with 17, 16, and 5 months with luminal A, luminal B, and basal-like subtypes, respectively (P<0.001). After propensity score matching, 5-year OS rates were 56% vs. 40% in the surgery vs. systemic therapy alone groups (P=0.018).
CONCLUSION: Surgical resection of BCLM yielded higher OS compared with systemic therapy alone and prolonged PFS among patients with the HER2-enriched subtype. These findings support the use of surgical therapy in appropriately selected patients, based on intrinsic subtypes.
KEYWORDS: Breast cancer, Liver, Metastases, Surgery, Subtypes
DOI: 10.1016/j.ejso..03.214
如果觉得《不同类型乳腺癌肝转移切除术生存结局》对你有帮助，请点赞、收藏，并留下你的观点哦！
