Liver metastases from breast cancer: the relationship between clinical, biochemical and pathological features and survival.

The clinical records of 312 consecutive patients with liver metastases from breast cancer were reviewed. The primary tumours were commonly poorly differentiated, although the majority were steroid receptor positive. At diagnosis of liver metastases, 60% of patients had hepatomegaly, 13% were jaundiced and 7% had ascites. A raised serum aspartate transaminase (AST) was the most common biochemical abnormality (84%), with 54% of patients having an AST of more than twice the upper limit of normal. The median survival from the time of diagnosis of liver metastases was 3.8 months. No feature existing prior to the development of liver metastases influenced subsequent survival. The presence of jaundice (P less than 0.001), ascites (P = 0.01) or hepatomegaly (P = 0.01) were all associated with a particularly poor prognosis. While any degree of elevation of bilirubin (P less than 0.001) or alkaline phosphatase (P = 0.003) was unfavourable, a raised AST alone was not predictive of shorter survival. AST only influenced survival significantly when above twice the upper limit of normal (P less than 0.001), with prognosis then progressively worsening the more elevated the level. Multivariate analysis using the Cox model suggested that the degree of elevation of AST was the single most important prognostic factor for survival after the diagnosis of liver metastases.