Markar Sheraz R, Mackenzie Hugh, Mikhail Sameh, Mughal Muntzer, Preston Shaun R, Maynard Nick D, Faiz Omar, Hanna George B
Division of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, South Wharf Road, London, W21NY, UK.
Department of General Surgery, Cairo University, Giza, Egypt.
Gastric Cancer. 2017 Mar;20(2):379-386. doi: 10.1007/s10120-016-0604-6. Epub 2016 Mar 3.
The objectives of this national study were to examine the short-term safety and long-term survival benefit associated with surgical resection of hepatic metastases from gastric cancer.
Patients from the Hospital Episode Statistics database were classified by disease and treatment approach. Gastric cancer: 1. Without liver metastases treated by gastrectomy (GG). 2. With liver metastases treated by gastrectomy and hepatectomy (GGH). 3. With liver metastases treated by gastrectomy without hepatectomy (GGNH). 4. With liver metastases treated with no surgery (GNS). Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics.
During the study period, 87,482 were patients diagnosed with gastric cancer, of whom 13,841 underwent partial or total gastrectomy. Of those who underwent gastrectomy, 336 had a diagnosis of liver metastases and 78 of these had a hepatectomy. Propensity-matched analysis showed no significant differences in 30- or 90-day mortality between the GGH and GG groups. The GGH group had significantly improved 1-year mortality (35.9 % vs. 50.0 %, p = 0.049) and 5-year mortality (61.5 % vs. 75.7 %, p = 0.031) compared to the GGNH group, and compared to the GNS group, the GCH group had 1-year mortality (35.9 % vs. 84.6 %, p < 0.001) and 5-year mortality (61.5 % vs. 90.8 %, p < 0.001).
This study showed that hepatectomy for synchronous gastric cancer hepatic metastases may carry survival benefits in selected patients. The data presented should not be a rationale to change current clinical practice but rather a stimulus to prospectively study the role of surgery in a selected group of patients who are currently treated with palliative chemotherapy.
本全国性研究的目的是探讨胃癌肝转移手术切除的短期安全性和长期生存获益。
从医院事件统计数据库中选取患者，根据疾病和治疗方法进行分类。胃癌：1. 无肝转移，接受胃切除术（GG）。2. 有肝转移，接受胃切除术和肝切除术（GGH）。3. 有肝转移，接受胃切除术但未行肝切除术（GGNH）。4. 有肝转移，未接受手术治疗（GNS）。采用倾向评分匹配和多变量分析来弥补某些基线特征的差异。
在研究期间，87482例患者被诊断为胃癌，其中13841例行部分或全胃切除术。在接受胃切除术的患者中，336例诊断为肝转移，其中78例行肝切除术。倾向评分匹配分析显示，GGH组和GG组在30天或90天死亡率方面无显著差异。与GGNH组相比，GGH组的1年死亡率（35.9%对50.0%，p = 0.049）和5年死亡率（61.5%对75.7%，p = 0.031）显著改善；与GNS组相比，GCH组的1年死亡率（35.9%对84.6%，p < 0.001）和5年死亡率（61.5%对90.8%，p < 0.001）。
本研究表明，同步性胃癌肝转移行肝切除术可能使部分患者获得生存获益。所呈现的数据不应成为改变当前临床实践的理由，而应促使对手术在一组目前接受姑息化疗的特定患者中的作用进行前瞻性研究。
