Cheon S H, Rha S Y, Jeung H-C, Im C-K, Kim S H, Kim H R, Ahn J B, Roh J K, Noh S H, Chung H C
Department of Internal Medicine, Cancer Metastasis Research Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Ann Oncol. 2008 Jun;19(6):1146-53. doi: 10.1093/annonc/mdn026. Epub 2008 Feb 27.
The benefit of surgical resection of liver metastases from gastric cancer has not been well established. The aim of this study was to evaluate the rationale for hepatic resection in patients with hepatic metastases from gastric cancer.
Among 10 259 patients diagnosed with gastric adenocarcinoma in the Yonsei University Health System from 1995 to 2005, we reviewed the records of 58 patients with liver-only metastases from gastric cancer who underwent gastric resection regardless of hepatic surgery.
The overall 1-year, 3-year, and 5-year survival rates of 41 patients who underwent hepatic resection with curative intent were 75.3%, 31.7%, and 20.8%, respectively, and three patients survived >7 years. Of the 41 patients, 22 had complete resection and 19 had palliative resection. Between the curative and palliative resections, survival rates after curative intent were not different. The number of liver metastasis (solitary or multiple) was a marginally significant prognostic factor for survival.
Surgery for liver metastases arising from gastric adenocarcinoma is reasonable if complete resection seems feasible after careful preoperative staging, even if complete resection is not actually achieved. Hepatic resection should be considered as an option for gastric cancer patients with hepatic metastases.
胃癌肝转移行手术切除的获益尚未明确。本研究旨在评估胃癌肝转移患者肝切除的理论依据。
在1995年至2005年延世大学健康系统诊断为胃腺癌的10259例患者中，我们回顾了58例仅发生肝转移且接受了胃切除（无论是否行肝脏手术）的胃癌患者的记录。
41例行根治性肝切除的患者1年、3年和5年总生存率分别为75.3%、31.7%和20.8%，3例患者生存超过7年。41例患者中，22例行根治性切除，19例行姑息性切除。根治性切除和姑息性切除之间，根治性切除后的生存率无差异。肝转移灶数量（单发或多发）是生存的一个边缘性显著预后因素。
对于胃腺癌肝转移患者，如果术前仔细分期后似乎可行根治性切除，即使实际上未实现根治性切除，手术也是合理的。肝切除应被视为胃癌肝转移患者的一种选择。
