Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis

Ting ZOU; Xiaowen LIU

doi:10.19401/j.cnki.1007-3639.2023.06.008

您当前的位置：

首页 >

文章列表页 >

Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis

Article | 更新时间：2025-12-31

- Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis
- China Oncology Vol. 33, Issue 6, Pages: 605-612(2023)
- 作者机构：
  
  复旦大学附属肿瘤医院胃外科,复旦大学上海医学院肿瘤学系,上海 200032
- 作者简介：
  
  LIU Xiaowen.
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.06.008
  CLC： R735.2
- Received：31 March 2023，
  
  Revised：2023-04-16，
  
  Published：30 June 2023
- 稿件说明：
移动端阅览
Ting ZOU, Xiaowen LIU. Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis[J]. China Oncology, 2023, 33(6): 605-612.
DOI：

Ting ZOU, Xiaowen LIU. Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis[J]. China Oncology, 2023, 33(6): 605-612. DOI： 10.19401/j.cnki.1007-3639.2023.06.008.

摘要

背景与目的：

胃癌同时性肝转移（gastric cancer with synchronous liver metastases，GCLM）患者是否接受肝切除仍存在争议。本研究通过分析GCLM患者的临床病理学特征及治疗方式，探究其与患者预后的关系，希望为该病的临床治疗及预后评价提供参考依据。

方法：

回顾性分析2006年3月—2018年8月复旦大学附属肿瘤医院收治的经术后病理学检查诊断为胃腺癌，影像学检查提示伴有肝转移的患者资料，包括性别、年龄、原发灶大小、部位、浸润深度、淋巴结转移、分化程度、肝转移灶大小、分布、数目、治疗方法及甲胎蛋白（alpha fetoprotein，AFP）、癌胚抗原（carcinoembryonic antigen，CEA）等肿瘤标志物水平，并进行随访。采用Kaplan-Meier生存曲线分析患者的总生存期（overall survival，OS），用log-rank检验进行单因素分析，COX回归模型进行多因素分析，探究影响GCLM患者生存的独立预后因素，通过亚组分析筛选最佳的肝切除对象。

结果：

79例纳入本研究的GCLM患者的中位发病年龄为63岁，男女比例为5.58∶1.00。中位OS为11个月，1、3和5年OS率分别为46.0%、23.3%和6.9%。单因素分析结果显示，影响OS的因素包括胃原发灶大小、分化程度、肝转移灶的分布、确诊时血清AFP水平及肝切除。多因素分析结果显示，影响OS的独立危险因素为双叶肝转移（HR = 37.253，

= 0.008），保护因素为肝切除（HR = 0.149，

= 0.044）。进一步亚组分析显示，对转移灶最大直径≤3 cm、单发肝转移灶、单叶转移、确诊时血清AFP及CEA水平正常者，肝切除有可能改善其OS。

结论：

回顾性研究表明肝切除有可能改善部分GCLM患者的预后。

Abstract

Background and purpose:

Whether patients with gastric cancer with synchronous liver metastases (GCLM) receive hepatectomy remains controversial. In this study

we analyzed the clinicopathological characteristics and treatment modalities of patients with GCLM to investigate their relationship with prognosis

hoping to provide a reference basis for the clinical treatment and prognostic evaluation of this disease.

Methods:

The patients admitted to the Fudan University Shanghai Cancer Center from March 2006 to August 2018 who were diagnosed with gastric adenocarcinoma by postoperative pathology and liver metastases by imaging examination were retrospectively analyzed

including gender

age

primary tumor size

location

depth of invasion

lymph node metastasis

differentiated degree

metastatic tumor size

distribution

number

the treatment

serum alpha fetoprotein (AFP) and carcinoembryonic antigen (CEA) level at diagnosis

and combined with follow-up investigation. The Kaplan-Meier method was used to analyze the overall survival (OS) of the patients

log-rank test was applied for univariate analysis

and the COX regression model was used for multifactorial analysis to explore the independent prognostic factors affecting the OS of patients with GCLM. The best target for hepatectomy was screened by further subgroup analysis.

Results:

The median age of onset in 79 patients with GCLM admitted to this study was 63 years

and the male to female ratio was 5.58

1.00. The median OS was 11 months

the 1-year

3-year and 5-year OS rates were 46.0%

23.3%

and 16.9%

respectively. The results of the univariate analysis showed that the factors affecting OS include primary tumor size

differentiated degree

hepatic tumor distribution

serum AFP level at diagnosis and hepatectomy. The results of multivariate analysis showed that the independent risk factor affecting OS was bilateral liver metastasis (HR = 37.253

= 0.008)

and the protective factor was hepatectomy (HR = 0.149

= 0.044). Further subgroup analysis showed that hepatectomy improved OS in the subgroup with metastatic tumor size ≤3 cm

single liver metastasis

unilateral metastasis and normal serum AFP and CEA levels at diagnosis.

Conclusion:

Retrospective study suggests that hepatectomy may improve the prognosis of some patients with GCLM.

关键词

Keywords

references

SUNG H , FERLAY J , SIEGEL R L , et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin , 2021 , 71 ( 3 ): 209 - 249 . DOI: 10.3322/caac.v71.3 http://doi.org/10.3322/caac.v71.3 https://onlinelibrary.wiley.com/toc/15424863/71/3 https://onlinelibrary.wiley.com/toc/15424863/71/3

FERLAY J , STELIAROVA-FOUCHER E , LORTET-TIEULENT J , et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012 [J ] . Eur J Cancer , 2013 , 49 ( 6 ): 1374 - 1403 . DOI: 10.1016/j.ejca.2012.12.027 http://doi.org/10.1016/j.ejca.2012.12.027

SHAH M A , KELSEN D P . Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease [J ] . J Natl Compr Canc Netw , 2010 , 8 ( 4 ): 437 - 447 . DOI: 10.6004/jnccn.2010.0033 http://doi.org/10.6004/jnccn.2010.0033 https://jnccn.org/view/journals/jnccn/8/4/article-p437.xml https://jnccn.org/view/journals/jnccn/8/4/article-p437.xml

CONDE MONROY D , IBAÑEZ-PINILLA M , SABOGAL J C , et al. Survival outcomes of hepatectomy in gastric cancer liver metastasis: a systematic review and meta-analysis [J ] . J Clin Med , 2023 , 12 ( 2 ): 704 . DOI: 10.3390/jcm12020704 http://doi.org/10.3390/jcm12020704 https://www.mdpi.com/2077-0383/12/2/704 https://www.mdpi.com/2077-0383/12/2/704

GARANCINI M , UGGERI F , DEGRATE L , et al. Surgical treatment of liver metastases of gastric cancer: is local treatment in a systemic disease worthwhile? [J ] . HPB (Oxford) , 2012 , 14 ( 3 ): 209 - 215 . DOI: 10.1111/j.1477-2574.2011.00428.x http://doi.org/10.1111/j.1477-2574.2011.00428.x https://linkinghub.elsevier.com/retrieve/pii/S1365182X15305657 https://linkinghub.elsevier.com/retrieve/pii/S1365182X15305657

MIKI Y , FUJITANI K , HIRAO M , et al. Significance of surgical treatment of liver metastases from gastric cancer [J ] . Anticancer Res , 2012 , 32 ( 2 ): 665 - 670 .

ROMANO F , GARANCINI M , UGGERI F , et al. Surgical treatment of liver metastases of gastric cancer: state of the art [J ] . World J Surg Oncol , 2012 , 10 : 157 . DOI: 10.1186/1477-7819-10-157 http://doi.org/10.1186/1477-7819-10-157

CHEN L , SONG M Q , LIN H Z , et al. Chemotherapy and resection for gastric cancer with synchronous liver metastases [J ] . World J Gastroenterol , 2013 , 19 ( 13 ): 2097 - 2103 . DOI: 10.3748/wjg.v19.i13.2097 http://doi.org/10.3748/wjg.v19.i13.2097 http://www.wjgnet.com/1007-9327/full/v19/i13/2097.htm http://www.wjgnet.com/1007-9327/full/v19/i13/2097.htm

FUJITANI K , YANG H K , MIZUSAWA J , et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial [J ] . Lancet Oncol , 2016 , 17 ( 3 ): 309 - 318 . DOI: S1470-2045(15)00553-7 http://doi.org/S1470-2045(15)00553-7

GRANIERI S , ALTOMARE M , BRUNO F , et al. Surgical treatment of gastric cancer liver metastases: systematic review and meta-analysis of long-term outcomes and prognostic factors [J ] . Crit Rev Oncol Hematol , 2021 , 163 : 103313 . DOI: 10.1016/j.critrevonc.2021.103313 http://doi.org/10.1016/j.critrevonc.2021.103313 https://linkinghub.elsevier.com/retrieve/pii/S1040842821001013 https://linkinghub.elsevier.com/retrieve/pii/S1040842821001013

MINCIUNA C E , TUDOR S , MICU A , et al. Safety and efficacy of simultaneous resection of gastric carcinoma and synchronous liver metastasis-a western center experience [J ] . Medicina (Kaunas) , 2022 , 58 ( 12 ): 1802 .

YAMAGUCHI T , TAKASHIMA A , NAGASHIMA K , et al. Evaluating the efficacy of post-operative chemotherapy after curative resection of stage Ⅳ gastric cancer with synchronous oligo metastasis: a multicenter retrospective study [J ] . Gastric Cancer , 2023 , 26 ( 2 ): 307 - 316 . DOI: 10.1007/s10120-023-01363-8 http://doi.org/10.1007/s10120-023-01363-8

CUI J K , LIU M , SHANG X K . Hepatectomy for liver metastasis of gastric cancer: a meta-analysis [J ] . Surg Innov , 2019 , 26 ( 6 ): 692 - 697 . DOI: 10.1177/1553350619856491 http://doi.org/10.1177/1553350619856491 http://journals.sagepub.com/doi/10.1177/1553350619856491 http://journals.sagepub.com/doi/10.1177/1553350619856491

OCHIAI T , SASAKO M , MIZUNO S , et al. Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors [J ] . Br J Surg , 1994 , 81 ( 8 ): 1175 - 1178 . DOI: 10.1002/bjs.1800810832 http://doi.org/10.1002/bjs.1800810832 https://academic.oup.com/bjs/article/81/8/1175/6165737 https://academic.oup.com/bjs/article/81/8/1175/6165737

MARTE G , TUFO A , STECCANELLA F , et al. Efficacy of surgery for the treatment of gastric cancer liver metastases: a systematic review of the literature and meta-analysis of prognostic factors [J ] . J Clin Med , 2021 , 10 ( 5 ): 1141 . DOI: 10.3390/jcm10051141 http://doi.org/10.3390/jcm10051141 https://www.mdpi.com/2077-0383/10/5/1141 https://www.mdpi.com/2077-0383/10/5/1141

OHKURA Y , SHINOHARA H , HARUTA S , et al. Hepatectomy offers superior survival compared with non-surgical treatment for≤3 metastatic tumors with diameters < 3 cm from gastric cancer: a retrospective study [J ] . World J Surg , 2015 , 39 ( 11 ): 2757 - 2763 . DOI: 10.1007/s00268-015-3151-0 http://doi.org/10.1007/s00268-015-3151-0 http://link.springer.com/10.1007/s00268-015-3151-0 http://link.springer.com/10.1007/s00268-015-3151-0

OKI E , TOKUNAGA S , EMI Y , et al. Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302) [J ] . Gastric Cancer , 2016 , 19 ( 3 ): 968 - 976 . DOI: 10.1007/s10120-015-0530-z http://doi.org/10.1007/s10120-015-0530-z

WANG Y N , SHEN K T , LING J Q , et al. Prognostic analysis of combined curative resection of the stomach and liver lesions in 30 gastric cancer patients with synchronous liver metastases [J ] . BMC Surg , 2012 , 12 : 20 . DOI: 10.1186/1471-2482-12-20 http://doi.org/10.1186/1471-2482-12-20 https://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-12-20 https://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-12-20

KINOSHITA T , KINOSHITA T , SAIURA A , et al. Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases [J ] . Br J Surg , 2015 , 102 ( 1 ): 102 - 107 . DOI: 10.1002/bjs.9684 http://doi.org/10.1002/bjs.9684

TIBERIO G A , MINISTRINI S , GARDINI A , et al. Factors influencing survival after hepatectomy for metastases from gastric cancer [J ] . Eur J Surg Oncol , 2016 , 42 ( 8 ): 1229 - 1235 . DOI: 10.1016/j.ejso.2016.03.030 http://doi.org/10.1016/j.ejso.2016.03.030

UGGERI F , RIPAMONTI L , PINOTTI E , et al. Is there a role for treatment-oriented surgery in liver metastases from gastric cancer? [J ] . World J Clin Oncol , 2020 , 11 ( 7 ): 477 - 494 . DOI: 10.5306/wjco.v11.i7.477 http://doi.org/10.5306/wjco.v11.i7.477

CHEN J , TANG Z , DONG X , et al. Radiofrequency ablation for liver metastasis from gastric cancer [J ] . Eur J Surg Oncol , 2013 , 39 ( 7 ): 701 - 706 . DOI: 10.1016/j.ejso.2013.03.023 http://doi.org/10.1016/j.ejso.2013.03.023

ZHANG K C , CHEN L . Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases [J ] . Ther Adv Med Oncol , 2020 , 12 : 1758835920904803 .

KATAOKA K , KINOSHITA T , MOEHLER M , et al. Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG [J ] . Gastric Cancer , 2017 , 20 ( 5 ): 904 - 912 . DOI: 10.1007/s10120-017-0696-7 http://doi.org/10.1007/s10120-017-0696-7

VIGANÒ L , VELLONE M , FERRERO A , et al. Liver resection for gastric cancer metastases [J ] . Hepato-gastroenterology , 2013 , 60 ( 123 ): 557 - 562 .

YUKAMI H , KAWAZOE A , LIN Y T , et al. Updated efficacy outcomes of anti-PD-1 antibodies plus multikinase inhibitors for patients with advanced gastric cancer with or without liver metastases in clinical trials [J ] . Clin Cancer Res , 2022 , 28 ( 16 ): 3480 - 3488 . DOI: 10.1158/1078-0432.CCR-22-0630 http://doi.org/10.1158/1078-0432.CCR-22-0630

Views

960

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

A study on the immunomicroenvironment characteristics of gastric cancer with neuroendocrine neoplasm and pure gastric cancer

Prospective trial on impact of oral nutritional supplements on elderly patients with nutritional risk after radical surgery for gastric cancer

Research progress and future perspectives of anticancer drug-induced interstitial lung disease/pneumonia in gastric cancer

Discovery and preliminary validation of five early gastric cancer biomarkers, including TAGLN2 and CTSD, based on serum proteomics

Artificial intelligence in gastric cancer diagnosis, treatment and prognostic prediction: current application and future perspective

Related Author

ZHANG Yi

SUN Haidong

QU Xinglong

ZHAO Bin

Qiulei XI

Xinyi WANG

Shanjun TAN

Zhige ZHANG

Related Institution

Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Department of Surgical Oncology, Minhang Branch, Fudan University Shanghai Cancer Center

Department of Gastrointestinal Surgery, General Surgery, Zhongshan Hospital, Fudan University

Department of Clinical Nutrition, Zhongshan Hospital, Fudan University

Department of Medical Oncology, The First Hospital of China Medical University

AI问答

⁰