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

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 vs 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, P = 0.008), and the protective factor was hepatectomy (HR = 0.149, P = 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.

Keywords

• |gastric cancer|synchronous liver metastases|hepatectomy