Journal of Clinical Oncology, Vol 5, 773-782, Copyright © 1987 by American Society of Clinical Oncology
Clinical course of breast cancer patients with liver metastases
JW Zinser, GN Hortobagyi, AU Buzdar, TL Smith and G Fraschini
Between June 1973 and November 1980, 1,171 patients with metastatic breast
cancer were treated with various doxorubicin-containing regimens at our
institution (M.D. Anderson Hospital and Tumor Institute, Houston).
Retrospective analysis of all 233 cases (20%) with liver metastases was
done to correlate various clinical and biochemical characteristics with
response to treatment, survival, and causes of death. A similar analysis
was performed for 58 consecutive patients with liver metastases treated at
this hospital between December 1955 and December 1957 with hormone therapy
or single-agent chemotherapy. Objective responses were observed in 132 of
233 patients (57%) treated with combination chemotherapy. The median
survival was 14 months in the 1970s and 5 months in the 1950s. Among
patients who had liver metastases at the time of initial diagnosis of
breast cancer, survival was longer for the group treated with combination
chemotherapy. All cases were classified according to the number of organ
sites involved by metastases. Patients with only liver metastases, or liver
plus bone lesions had the longest survival. Other clinical and biochemical
factors that correlated significantly with longer survival were: no prior
chemotherapy, performance status of 1 to 2, absence of ascites, normal
bilirubin and lactic dehydrogenase (LDH), SGOT less than or equal to 2
times normal and albumin greater than 4.5 g/dL. The main cause of death was
multiorgan failure, with only 20% of patients dying of liver failure. The
present study shows that the presence of liver metastases in breast cancer
is not by itself an ominous factor. Most patients respond to therapy, and
significant palliation with extended survival is possible for several
prognostic subgroups. Further improvement in length and quality of survival
is expected with earlier diagnosis.
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