Treatment and prognostic factor analysis of metachronous liver metastases from gastric cancer / 中华消化外科杂志

ABSTRACT

Objective To explore the treatment methods and prognostic factors of metachronous liver metastases from gastric cancer.Methods The clinicopathological data of 102 patients with metachronous liver metastases from gastric cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 1996 to December 2008 were retrospectively analyzed.Sixty-four patients received systemic chemotherapy,19 received systemic chemotherapy + transcatheter arterial chemoembolization (TACE),and 19 received systemic chemotherapy + radical resection of the metachronous liver cancer.Patients were re-examined every 3 months within the first 3 years after operation,and every 6 months after postoperative year 3,and every 1 year after postoperative year 5.Physical examination,laboratory test and imaging examination were done during the follow-up.The followup was ended in October 2013.The cumulative survival rates of the patients were calculated and compared using the Kaplan-Meier method and the Log-rank test,respectively.The prognostic factors were analyzed using the COX regression model.Results The disease was alleviated in 15 patients,progressed in 27 patients,and the condition was stable in 22 patients after systemic chemotherapy.The disease was alleviated in 6 patients,progressed in 4 patients and the condition was stable in 9 patients after systemic chemotherapy + TACE.Of the 19 patients received systemic chemotherapy + radical resection of the metachronous liver cancer,1 was complicated with incisional infection,and no patient died perioperatively.Sixteen patients died of gastric cancer recurrence including 10 patients with local recurrence and 6 patients with multiple lesions recurrence.Eight patients missed the follow-up,the others were followed up for 9-149 months.The overall median survival time was 8 months (range,2-70 months),and the 1-,3-,5-year survival rates were 40.2％,17.7％ and 6.8％,respectively.The median survival time of the 64 patients who received systemic chemotherapy was 5 months (range,2-37 months),and the 1-,3-,5-year survival rates were 15.6％,3.5％ and 0,respectively.The median survival time of the 19 patients who received systemic chemotherapy +TACE was 6 months (range,3-36 months),and the 1-,3-,5-year survival rates were 26.1％,6.5％ and 0,respectively.The median survival time of the 19 patients who received systemic chemotherapy + radical resection of the metachronous liver cancer was 15 months (range,5-70 months),and the 1-,3-,5-year survival rates were 63.2％,31.6％ and 16.8％,respectively.The prognosis of patients who received systemic chemotherapy + radical resection of the metachronous liver cancer was superior to those who received systemic chemotherapy or systemic chemotherapy + TACE (x2=23.900,P ＜ 0.05).The results of univariate analysis showed that diameter and differentiation of primary tumor,extra-hepatic metastasis,type and number of liver metastases and treatment regimen were correlated with the prognosis of patients with metachronous liver metastases from gastric cancer (x2=6.307,7.908,4.375,45.188,18.234,23.900,P ＜ 0.05).The results of multivariate analysis showed that type and number of liver metastases were independent factors influencing the prognosis of patients with metachronous liver metastases from gastric cancer (OR=5.217,3.292,95％CI1.428-2.882,1.054-2.514,P＜0.05).Conclusions Surgical resection of the metachronous liver cancer is important to improve the survival of patients.The type and number of liver metastases are important factors in deciding the treatment methods.