乳腺癌肝转移特征及诊疗

doi:10.3969/j.issn.1009-976X.2021.03.004

岭南现代临床外科 ›› 2021, Vol. 21 ›› Issue (03): 272-277.DOI: 10.3969/j.issn.1009-976X.2021.03.004

乳腺癌肝转移特征及诊疗

杨文倩^#, 林婉宜^#, 龚畅^*

中山大学孙逸仙纪念医院逸仙乳腺肿瘤医院,广州 510289

通讯作者: *龚畅,Email：changgong282@163.com; gchang@mail.sysu.edu.cn
作者简介:龚畅,主任医师,外科学博士,博士生导师,中山大学孙逸仙纪念医院逸仙乳腺肿瘤医院乳腺外科主任医师,乳腺诊断专科主任,法国博士后,英国访问学者; 以第一/通讯作者在肿瘤和外科领域的专业期刊Cancer Cell,Molecular Cancer, Nature Communications, Autophagy, Cancer Research,Oncogene, Oncologist等杂志发表论文30篇,单篇最高他引377次,入选ESI高被引论文; 先后主持科技部国家重点研发计划（课题组长）1项、主持国家自然科学基金项目6项、省部级基金7项; 入选教育部新世纪优秀人才、科技部中法杰出青年科研人员交流计划,广东省杰青、广东省杰出青年医学人才、广东特支计划青年拔尖人才、珠江科技新星;
中国女医师协会临床肿瘤专业委员会委员、中国抗癌协会肿瘤标志专业委员会肿瘤多学科诊断（MDD）协作组委员、中国抗癌协会乳腺癌专业委员会康复学组委员、广东省医师协会乳腺专科医师分会副主任委员、青年学组组长、广州市抗癌协会乳腺癌分会副主任委员、广东省胸部肿瘤防治委员会常委、广东省保健协会乳腺分会常委、广东省药学会区域伦理委员会委员、广东省抗癌协会遗传性肿瘤分会委员; 《中华乳腺病杂志（电子版）》中青年编委、《中华临床医师杂志（电子版）》通讯编委、《岭南现代临床外科》编委
#并列第一作者。
基金资助:
科技部国家重大研发计划项目(2017YFC1309103、2017YFC1309104); 国家自然科学基金面上项目(81672594、81772836、81872139、82072907); 广州再生医学与健康广东省实验室临床创新研究项目（2018GZR0201004）; 中山大学孙逸仙纪念医院逸仙临床研究培育项目（SYS-C-201805）; 国自然重点（51861125203）; 北京市希思科临床肿瘤学研究基金会项（Y-Roche2019/2-0078）; 广东省科技发展专项资金（国际科技合作领域）(2021A0505030082); 广东省恶性肿瘤表观遗传与基因调控重点实验室开放课题(2020B1212060018OF007)

Characteristics on diagnosis and treatment of breast cancer patients with liver metastasis

YANG Wen-qian, LIN Wan-yi, GONG Chang

Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University

Online:2021-06-20 Published:2021-08-20
Contact: GONG Chang, changgong282@163.com or gchang@mail.sysu.edu.cn

摘要/Abstract

摘要： 乳腺癌发病人数逐年攀升,相较于其他部位转移的患者,乳腺癌肝转移患者通常预后较差。目前国内外尚无针对乳腺癌肝转移诊疗的指南。本文旨在为乳腺癌肝转移的临床诊疗提供一定的思路和依据。本文对乳腺癌肝转移临床特点、发病机制的研究现状与治疗进展进行综述。早期肝转移患者往往没有明显症状或体征,考虑肝转移的患者最好行影像学引导下穿刺确诊。随着乳腺癌新的药物及疗法的开发,肝转移患者生存较前有显著改善,部分患者也可从局部治疗中获得生存获益。对于发生肝转移的乳腺癌患者,有效的全身治疗是延长患者生存期的关键,部分经过选择的患者也可同时从局部治疗中获益。

关键词: 乳腺癌, 肝转移, 局部手术治疗, 立体定向放射治疗, 分子靶点治疗, 化疗

Abstract: The incidence of breast cancer is increasing year by year. Compared with other organ metastasis, the prognosis of breast cancer patients with liver metastases is usually poor. At present, there is no guideline for diagnosis and treatment of liver metastasis in breast cancer patients. The purpose of this paper is to provide ideas and suggestions for clinical diagnosis and treatment of breast cancer with liver metastases. Reviewed the clinical features, pathogenesis and therapy ofbreast cancer patients with liver metastases. When liver metastasis occurs, patients usually had no obvious symptoms or signs.It is strongly recommended thatliver metastasis should be pathologically diagnosed by percutaneous liver puncture. With the development of new drugs and therapies for breast cancer, the survival rate of patients with liver metastases has improved significantly, and some patients can also benefit from local treatment. Effective systemic therapy is the key to improve the survival of breast cancer patients with liver metastases. Some selected patients may also benefit from local treatment

Key words: breast cancer, liver metastasis, local treatment, stereotactic radiotherapy, molecular targeted therapy, chemotherapy

中图分类号:

杨文倩, 林婉宜, 龚畅. 乳腺癌肝转移特征及诊疗[J]. 岭南现代临床外科, 2021, 21(03): 272-277.

YANG Wen-qian, LIN Wan-yi, GONG Chang. Characteristics on diagnosis and treatment of breast cancer patients with liver metastasis[J]. Lingnan Modern Clinics In Surgery, 2021, 21(03): 272-277.

参考文献

[1] Sung H, Ferlay J, Siegel RL, et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] Gerratana L, Fanotto V, Bonotto M, et al.Pattern of metastasis and outcome in patients with breast cancer[J]. Clin Exp Metastasis, 2015, 32(2): 125-133.
[3] Igci A, Özkurt E.Management of Isolated Liver Metastasis[M]//Aydiner A, Igci A, Soran A.Breast Disease. Berlin: Springer, 2019: 597-606.
[4] Cristofanilli M, Hortobagyi GN.New horizons in treating metastatic disease[J]. Clin Breast Cancer, 2001, 1(4): 276-287.
[5] Eng LG, Dawood S, Sopik V, et al.Ten-year survival in women with primary stage IV breast cancer[J]. Breast Cancer Res Treat, 2016, 160(1): 145-152.
[6] Adam R, Aloia T, Krissat J, et al.Is liver resection justified for patients with hepatic metastases from breast cancer?[J]. Ann Surg, 2006,244(6):897-907.
[7] Khodari W, Sedrati A, Naisse I, et al.Impact of loco-regional treatment on metastatic breast cancer outcome: A review[J]. Crit Rev Oncol Hematol, 2013, 87(1): 69-79.
[8] Clements ME, Johnson RW.PREX1 drives spontaneous bone dissemination of ER+ breast cancer cells[J]. Oncogene, 2020, 39(6):1318-1334.
[9] Semenza GL.Cancer-stromal cell interactions mediated by hypoxia-inducible factors promote angiogenesis, lymphangiogenesis, and metastasis[J]. Oncogene,2013, 32(35):4057-4063.
[10] Liu Y, Cao X.Immunosuppressive cells in tumor immune escape and metastasis[J]. J Mol Med, 2015, 94(5): 509-522.
[11] Riès STB, Dupuy BF, Dong CZ, et al.Claudin-2 promotes breast cancer liver metastasis by facilitating tumor cell interactions with hepatocytes[J]. Mol Cell Biol, 2012, 32(15): 2979.
[12] Madankumar P, Naveenkumar P, Niranjalidevaraj S.Morin, a dietary flavonoid, exhibited anti-fibrotic effect and induced apoptosis of activated hepatic stellate cells by inhibiting canonical NF-κB signaling[J]. Biochimie, 2015, 110:107-118.
[13] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:Breast Cancer,version 5[Internet]. Fort Washington, PA:National Comprehensive Cancer Network; 2021.[cited June 28, 2021]. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
[14] Ji L, Cheng L, Zhu X, et al.Risk and prognostic factors of breast cancer with liver metastases[J]. BMC Cancer, 2021, 21(1):238.
[15] Cardoso F, Paluch-Shimon S, Senkus E, et al.5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)[J]. Ann Oncol, 2020, 31(12):1623-1649.
[16] Bialas M, Pankowska V, Bondos J, et al.Comparative assessment of hypofractionated radiation therapy and standard treatment in patients with prostate cancer[J]. J Clin Oncol, 34, 2016 (suppl): e16616.
[17] Goetz MP, Toi M, Campone M, et al.MONARCH 3: Abemaciclib As Initial Therapy for Advanced Breast Cancer[J]. J Clin Oncol, 2017, 35(32):3638-3646.
[18] Pbx A, Pmy B, Pfm A, et al.Pyrotinib plus capecitabine versus lapatinib plus capecitabine for the treatment of HER2-positive metastatic breast cancer (PHOEBE): a multicentre, open-label, randomised, controlled, phase 3 trial[J], Lancet Oncol, 2021, 22(3):351-360.
[19] Modi S, Saura C, Yamashita T, et al.Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer[J]. N Engl J Med, 2020, 382(7):610-621.
[20] Weinrich M, Weiβ C, Schuld J, et al.Liver Resections of Isolated Liver Metastasis in Breast Cancer: Results and Possible Prognostic Factors[J]. HPB Surg, 2014, 2014: 893829.
[21] Vertriest C, Berardi G, Tomassini F, et al.Resection of Single Metachronous Liver Metastases from Breast Cancer Stage I-II Yield Excellent Overall and Disease-Free Survival. Single Center Experience and Review of the Literature[J]. Dig Surg, 2015, 32(1): 52-59.
[22] Sabol M, Donat R, Chvalny P, et al.Surgical management of breast cancer liver metastases[J]. Neoplasma, 2014, 61(5): 601-606.
[23] Ruiz A, Castro-Benitez C, Sebagh M, et al.Repeat Hepatectomy for Breast Cancer Liver Metastases[J]. Ann Surg Oncol, 2015, 22(3): S1057-1066.
[24] Ruiz A, van Hillegersberg R, Siesling S, et al. Surgical resection versus systemic therapy for breast cancer liver metastases: Results of a European case matched comparison[J]. Eur J Cancer, 2018, 95: 1-10.
[25] Feng Y, He XG, Zhou CM, et al.Comparison of hepatic resection and systemic treatment of breast cancer liver metastases: A propensity score matching study[J]. Am J Surg, 2020, 220(4): 945-951.
[26] Kostov DV, Kobakov GL, Yankov DV.Prognostic Factors Related to Surgical Outcome of Liver Metastases of Breast Cancer[J]. J Breast Cancer, 2013, 16(2): 184-192.
[27] Margonis GA, Kim Y, Buettner S, et al.The role of liver-directed surgery in patients with hepatic metastasis from primary breast cancer: a multi-institutional analysis[J]. HPB (Oxford), 2016, 18(8):700-705.
[28] Dittmar Y, Altendorf-Hofmann A, Schüle S, et al.Liver resection in selected patients with metastatic breast cancer: a single-centre analysis and review of literature[J]. J Cancer Res Clin Oncol, 2013, 139(8):1317-1325.
[29] Sakamoto Y, Yamamoto J, Yoshimoto M, et al.Hepatic Resection for Metastatic Breast Cancer: Prognostic Analysis of 34 Patients[J]. World J Surg, 2005, 29(4): 524-527.
[30] Howlader M, Heaton N, Rela M.Resection of liver metastases from breast cancer: Towards a management guideline[J]. Int J Surg, 2011, 9(4): 285-291.
[31] He X, Zhang Q, Feng Y, et al.Resection of liver metastases from breast cancer: a multicentre analysis[J]. Clin Transl Oncol, 2020, 22(4):512-521.
[32] Lermite E, Marzano E, Chéreau E, et al.Surgical resection of liver metastases from breast cancer[J]. Surg Oncol, 2010, 19(4): e79-e84.
[33] Nicolae B, Irina B, Veronica I, et al.The Impact on the Long-term Outcomes of Hormonal Status After Hepatic Resection for Breast Cancer Liver Metastases[J]. In Vivo, 2018, 32(5): 1247-1253.
[34] Ercolani, Giorgio, Zanello, et al. Ten-Year Survival after Liver Resection for Breast Metastases: A Single-Center Experience[J]. Dig Surg, 2018, 35(4):372-380.
[35] Xiao YB, Zhang B, Wu YL.Radiofrequency ablation versus hepatic resection for breast cancer liver metastasis: a systematic review and meta-analysis[J]. J Zhejiang Univ Sci B, 2018, 19(11): 829-843.

乳腺癌肝转移特征及诊疗

Characteristics on diagnosis and treatment of breast cancer patients with liver metastasis

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