Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2012 Jan;125(2):165-71.
The prognosis for patients with gastric cancer and synchronous liver metastases is very poor. However, a standard therapeutic strategy has not been well established. The clinical benefit and prognostic factors after hepatic surgical treatment for liver metastases from gastric cancer remain controversial.
Records of 105 patients who underwent gastrectomy regardless of hepatic surgical treatment for gastric cancer with synchronous liver-only metastases in our center between 1995 and 2010 were retrospectively reviewed.
The overall survival rate for the 105 patients was 42.1%, 17.2%, and 10.6% at 1, 2, and 3 years, respectively, with a median survival time of 11 months. Multivariate survival analysis revealed that the extent of lymphadenectomy (D) (P < 0.001), lymph node metastases (P < 0.001), extent of liver metastases (H) (P = 0.008), and lymphovascular invasion (P = 0.002) were significant independent prognostic factors for survival. Among patients who underwent D2 lymphadenectomy, those who underwent hepatic surgical treatment had a significantly improved survival compared with those who underwent gastrectomy alone (median survival, 24 vs. 12 months; P < 0.001). However, hepatic surgical treatment was not a prognostic factor for patients who underwent D1 lymphadenectomy (median survival, 8 vs. 8 months; P = 0.495). For the 35 patients who underwent gastrectomy plus hepatic surgical treatment, D2 lymphadenectomy (P < 0.001), lymph node metastases (P = 0.015), and extent of liver metastases (H1 vs. H2 and H3) (P = 0.017) were independent significant prognostic factors for survival.
D2 lymphadenectomy plus hepatic surgical treatment may provide hope for long-term survival of judiciously selected patients with hepatic metastases from gastric cancer. Patients with a low degree of lymph node metastases and H1 liver metastases would make the most appropriate candidates. However, if D2 dissection cannot be achieved, hepatic surgical treatment is not recommended.
患有胃癌合并肝转移的患者预后极差。然而，目前尚未建立标准的治疗策略。对于胃癌肝转移患者行肝切除术的临床获益和预后因素仍存在争议。
回顾性分析 1995 年至 2010 年期间我院 105 例行胃癌切除术且伴有单纯肝转移的患者的临床资料，所有患者均未行肝切除术。
105 例患者的总生存率分别为 42.1%、17.2%和 10.6%，1、2、3 年的中位生存时间分别为 11 个月。多因素生存分析显示，淋巴结清扫范围（D）（P＜0.001）、淋巴结转移（P＜0.001）、肝转移范围（H）（P=0.008）和血管淋巴管侵犯（P=0.002）是影响生存的独立预后因素。行 D2 淋巴结清扫的患者中，行肝切除术患者的生存明显优于单纯行胃癌切除术的患者（中位生存时间：24 个月比 12 个月；P＜0.001）。然而，行 D1 淋巴结清扫的患者行肝切除术不是其预后因素（中位生存时间：8 个月比 8 个月；P=0.495）。在 35 例行胃癌切除术加肝切除术的患者中，D2 淋巴结清扫（P＜0.001）、淋巴结转移（P=0.015）和肝转移范围（H1 比 H2 和 H3）（P=0.017）是影响生存的独立显著预后因素。
D2 淋巴结清扫加肝切除术可能为有选择的胃癌肝转移患者带来长期生存的希望。低度淋巴结转移和 H1 肝转移的患者将成为最适合的候选者。然而，如果不能进行 D2 解剖，则不推荐行肝切除术。
