Department of Onco-Biological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan,
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Oncology. 2020;98(5):273-279. doi: 10.1159/000505555. Epub 2020 Feb 14.
Chemotherapy is generally recommended as the first-line standard treatment in patients with liver metastasis from gastric cancer. However, the clinical impact of surgical treatment remains unclear in responders after chemotherapy. The present study aimed to investigate the tumor response and prognosis after chemotherapy and to assess the clinical indication of conversion surgery in responders.
The study retrospectively reviewed the clinical data of 44 patients with liver metastasis from gastric cancer who were treated with chemotherapy between February 2002 and January 2019. These patients were classified into progressive disease (PD) and non-PD groups according to tumor response.
Among the 44 patients, 7 and 26 had peritoneal dissemination and ≥5 had metastatic liver nodules. Additionally, 15 and 29 patients had PD and non-PD, respectively. Surgical treatment was significantly correlated with tumor response (p < 0.0321). Prognostic differences between the PD and non-PD groups were significant (p < 0.0001). Moreover, gastrectomy and hepatectomy were significantly correlated with the number of liver metastases (≥5 vs. <5, respectively) in the non-PD group (p = 0.0025 and p = 0.0169, respectively). The 3-year survival rates among patients with non-PD undergoing both gastrectomy and hepatectomy (n = 6), gastrectomy alone (n = 7), and nonsurgical treatments (n = 16) were 100, 66.7, and 0%, respectively (p = 0.0026). Multivariate analysis identified peritoneal dissemination as an independent prognostic factor (p = 0.0225).
Our preliminary results suggest that conversion surgery for gastric cancer with liver metastasis might be clinically indicated in chemotherapy responders with <5 metastatic liver nodules and without peritoneal dissemination.
化疗通常被推荐为胃癌肝转移患者的一线标准治疗方法。然而，在化疗后应答者中，手术治疗的临床影响尚不清楚。本研究旨在探讨化疗后肿瘤的反应和预后，并评估应答者转化手术的临床适应证。
本研究回顾性分析了 2002 年 2 月至 2019 年 1 月期间接受化疗的 44 例胃癌肝转移患者的临床资料。根据肿瘤反应将这些患者分为进展性疾病（PD）和非 PD 组。
在 44 例患者中，7 例和 26 例有腹膜播散和≥5 个转移性肝结节。此外，15 例和 29 例患者分别为 PD 和非 PD。手术治疗与肿瘤反应显著相关（p<0.0321）。PD 组和非 PD 组之间的预后差异有统计学意义（p<0.0001）。此外，非 PD 组中胃切除术和肝切除术与肝转移灶数量（≥5 个与<5 个）显著相关（p=0.0025 和 p=0.0169）。非 PD 患者中同时行胃切除术和肝切除术（n=6）、仅行胃切除术（n=7）和非手术治疗（n=16）的 3 年生存率分别为 100%、66.7%和 0%（p=0.0026）。多因素分析表明腹膜播散是独立的预后因素（p=0.0225）。
我们的初步结果表明，对于化疗后应答者，若肝转移灶数量<5 个且无腹膜播散，胃癌伴肝转移的转化手术可能具有临床适应证。
