Xiao Yibin, Zhang Bo, Wu Yulian
Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Ir J Med Sci. 2019 May;188(2):415-424. doi: 10.1007/s11845-018-1864-4. Epub 2018 Jul 30.
The prognosis for patients with liver metastases from gastric cancer is very poor. Nevertheless, standard therapeutic strategies have not been established yet. The impact of hepatic surgical treatment on survival of patients with metachronous liver metastases from gastric cancer still remains controversial.
We conducted a retrospective analysis on records of 436 patients who received radical gastrectomy (with D2 lymphadenectomy, regardless of hepatic surgical treatment) for gastric cancer with metachronous (≥ 3 months after gastrectomy) liver metastases in our center between 2001 and 2016. All patients were followed until 2017/10/31 or withdrawn from the follow-up because of death.
The median interval for non-hepatic metastases of the 436 patients who underwent radical gastrectomy is 14 months. T (P = 0.041), N (P = 0.023) and lymphovascular invasion (P < 0.001) were independent predictors affecting liver metastases-free interval. The overall survival rates for the 436 patients were 44.5, 29.7, 16.3, and 16.3% at 1, 2, 3, and 5 years respectively since treatment of hepatic metastases, with a median survival time of 11 months. N (P = 0.025), extent of liver metastases (H) (H2 vs. H1, P = 0.036; H3 vs. H1, P < 0.001), and treatment of liver metastatic lesions (P < 0.001) were significant independent prognostic factors for survival after presence of liver metastases. Among H1 and H2 patients, median survival in hepatic surgical treatment group was significantly longer than that in systemic chemotherapy alone group (25 vs. 11 months, P = 0.015).
Liver examinations should be performed during the first 2 years after gastric surgery and continued for 5 years for high-risk patients. Active therapeutic strategies may prolong patients' survival compared with supportive treatment alone. Patients with H1, H2 metachronous liver metastases may be considered appropriate candidates for hepatic surgical treatment before embarking on systemic chemotherapy alone.
ISRCTN Registry (Retrospectively registered; Reference number: 35067; Date: 02/04/2018).
胃癌肝转移患者的预后非常差。然而，标准治疗策略尚未确立。胃癌异时性肝转移患者接受肝脏手术治疗对生存的影响仍存在争议。
我们对2001年至2016年期间在本中心接受根治性胃癌切除术（D2淋巴结清扫术，无论是否进行肝脏手术治疗）的436例异时性（胃癌切除术后≥3个月）肝转移患者的记录进行了回顾性分析。所有患者随访至2017年10月31日或因死亡退出随访。
436例行根治性胃癌切除术患者的非肝转移中位间隔时间为14个月。T（P = 0.041）、N（P = 0.023）和脉管侵犯（P < 0.001）是影响无肝转移间隔时间的独立预测因素。436例患者自肝转移治疗后1、2、3和5年的总生存率分别为44.5%、29.7%、16.3%和16.3%，中位生存时间为11个月。N（P = 0.025）、肝转移范围（H）（H2与H1相比，P = 0.036；H3与H1相比，P < 0.001）以及肝转移灶的治疗（P < 0.001）是肝转移出现后生存的显著独立预后因素。在H1和H2患者中，肝脏手术治疗组的中位生存时间显著长于单纯全身化疗组（25个月对11个月，P = 0.015）。
胃癌手术后前2年应进行肝脏检查，高危患者应持续检查5年。与单纯支持治疗相比，积极的治疗策略可能延长患者生存。对于H1、H2异时性肝转移患者，在单独进行全身化疗之前，可考虑作为肝脏手术治疗的合适候选者。
ISRCTN注册库（回顾性注册；注册号：35067；日期：2018年4月2日）。
