| Objective: The aim of this study was to perform a systematic review of outcome and prognostic factors for survival of liver metastasectomy for Gastric cancer(GC LM).Methods: The Pub Med,EMBASE,Cochrane Library,Medline,Springer Link,Wiley Online Library,C hina National K nowledge Infrastructure,Wanfang database,VIP database,The Chinese biomedical journal literature database were searched with the key words of gastric cancer, gastric carcinoma, hepatic, resection, hepatic resection, hepatectomy, liver metastases, hepatic metastases, surgery, surgical, survival, Prognostic.The time for retrieving was from January 1995 to August 2015.Literatures on long term efficacy and prognostic factors of radical resection of gastric carcinoma combined with hepatectomy for GCLM were retrieved, and data were analyzed and evaluated by 2 independent researchers. The count data were represented by the relative risk(RR) and 95% confidence interval(95%CI).The group rate was merged by the formula RR/(1+RR),corresponding 95%CI upper limit values were retransferred by the formula RR/(1+upper limit value RR, and the lower limit values were transferred by the formula RR(1+lower limit value RR).The comparison of group rates was done by indirect comparison, Z=difference between group rate/ the square root of the sum of standard erro r of each group rate. The heterogeneity was analyzed by I2 。Result:Eighteen literatures including 410 patients, who had gastric cancer radical resection and liver metastases resection were finally enrolled in this study. The results of Meta analysis showed:The summary RR of 3- year overall survival of surgical patients with GCLM was 0.47(95%CI 0.37~0.60),while the summary 3-year overall survival rate was 32.0%(95%CI 0.27~0.38).The summary RR of 5-year overall survival of surgical patients with GC LM was 0.35(95%CI 0.27~0.45),summary RR of 5-year overall survival rate was 25.9%(95%CI 0.21~0.31).The results of subgroup analysis showed: The summary 3-year survival rate of surgical patients with D2 lymphadenectomy at gastrectomy was 39%(95%CI 0.25~0.54); and summary 5-year survival rate was 34.6%(95%CI 0.25~0.45). The summary 3-year survival rate of surgical patients without D2 lymphadenectomy at gastrectomy was 28.6%(95% CI 0.23~0.35);and summary 5- year survival rate was 21.9%(95%CI 0.17~0.28).The summary 3-year survival rate of surgical patients with fibrous pseudocapsules around liver metastases was 31.5%(95% CI 0.21~0.44);and summary 5-year survival rate was 27%(95%CI 0.15~0.43). The summary 3-year survival rate of surgical patients without fibrous pseudocapsules around liver metastases was 32.0%(95% CI 0.26~0.38); and summary 5-year survival rate was 25.4%(95%CI 0.21~0.31). The summary 3-year survival rate of surgical patients with GCLM and had blood transfusions during hepatic resection was 22.5%( 95%CI 0.15~0.33);and summary 5-year survival rate was 16.7%(95%CI 0.11~0.25).The summary 3-year survival rate of surgical patients with GCLM and had no blood transfusions during hepatic resection was 34.6%(95%CI 0.29~0.41);and summary 5-year survival rate was 29.1%(95%CI 0.24~0.35).The summary 3-year survival rate of surgical patients with GCLM and primary carcinoma serosal invasion was 32.9%(95%CI 0.23~0.44), and summary 5-year survival rate was 25.9%(95%CI 0.16~0.40).The summary 3-year survival rate of surgical patients with GCLM and without primary carcinoma serosal invasion was 47.9%(95% CI 0.38~0.58),and summary 5-year survival rate was 38.3%(95% CI 0.29~0.49).The summary 3- year survival rate of surgical patients with synchronous hepatic metastases was 30.6%(95% CI 0.24~0.38),and summary 5- year survival rate was 24.2%(95% CI 0.18~0.32).The summary 3-year survival rate of surgical patients with metachronous hepatic metastases was 40.1%(95%CI 0.32~0.48), and summary 5-year survival rate was 32.9%(95% CI 0.25~0.41).The summary 3- year survival rate of surgical patients with solitary metastatic hepatic carcinoma was 47.6%(95% CI 0.40~0.56),and summary 5-year survival rate was 37.1%(95% CI 0.26~0.48).The summary 3-year survival rate of surgical patients with multiple metastatic hepatic carcinoma was 28.6%(95% CI 0.18~0.42),and summary 5-year survival rate was 15.3(95% CI 0.07~0.30). The summary 3- year survival rate of surgical patients with diameter ≥3cm was 39.4%(95% CI 0.28~0.52);and summary 5-year survival rate was 37.5%(95% CI 0.26~0.50).The summary 3-year survival rate of surgical patients with diameter <3cm was 36.3%(95% CI 0.26~0.48),and summary 5-year rate was 35.1%(95% CI 0.24~0.39).The summary 3-year survival rate of surgical patients with diameter ≥5cm was 40.1%(95% CI 0.20~0.64); and summary 5-year survival rate was 20.0%(95% CI 0.08~0.40).The summary 3-year survival rate of surgical patients with diameter <5cm was 38.3%(95% CI 0.24~0.55),and summary 5- year survival rate was 27.5%(95% CI 0.14~0.47). The summary 3-year survival rate of surgical patients with GCLM and R0 resection was 28.6%(95% CI 0.19~0.40),and summary 5-year survival rate was 20.0%( 95% CI 0.12~0.32).The summary 3- year survival rate of surgical patients with GCLM and without R0 resection was 0,and summary 5-year survival rate was 9.1%(95% CI 0.03~0.25).The summary 3- year survival rate of surgical patients with GC LM and resection margin <10mm was 13.0%(95% C I 0.05~0.30),and summary 5-year survival rate was 8.3%((95% CI 0.02~0.28).The summary 3-year survival rate of surgical patients with GCLM and resection margin ≥10mm was 34.6%(95% CI 0.21~0.52),and summary 5-year survival rate was 34.6%(95% CI 0.21~0.52).The summary 3-year survival rate of surgical patients with GC LM and chemotherapy was 45.9%(95% CI 0.29~0.64),and summary 5-year survival rate was 29.1%(95% CI 0.19~0.42).The summary 3- year survival rate of surgical patients with GCLM and without chemotherapy was 38.7%(95% CI 0.26~0.53),and the summary 5-year survival rate was 25.4%(95% CI 0.18~0.35).The summary of overall recurence rate of surgical patients with GC LM was74.7%(95% CI 0.69~0.80),while the subgroup analysis showed: The group of chemotherapy and nonchemotherapy had a recurrence rate were 73.5%(95% CI 0.67~0.79),77.3%(95% CI 0.67~0.85),respectively. The summary of remnant liver recurrence of surgical patients with GCLM was 58.2%(95% CI 0.48~0.68),while the subgroup analysis showed: The group of chemotherapy and non-chemotherapy had a recurrence rate were 55.4%(95% CI0.40~0.70),62.0%(95% CI 0.51~0.72),respectively. The 3-year survival rate of surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases, solitary metastatic hepatic carcinoma,R0 resection and resection margin≥10mm was statistically significantly higher than that of surgical patients with primary carcinoma serosal invasion, synchronous hepatic metastases, multiple metastatic hepatic carcinoma and resection margin < 10 mm and without R0 resection(Z=2.118,1.999,3.018,5.295,2.183,P<0.05).The 5-year survival rate of surgical patients with solitary metastatic hepatic carcinoma and resection margin ≥10mm was statistically significantly higher than that of surgical patients without multiple metastatic hepatic carcinoma and resection margin <10mm(Z=4.528,2.819,P<0.05).Conclusion: Overall long-term efficacy of surgical patients with GCLM is not good enough. There is the better prognosis in the surgical patients without primary carcinoma serosal invasion and patients with D2 lymphadenectomy at gastrectomy, metachronous hepatic metastases,solitary metastatic hepatic carcinoma,R0 resection and resection margin≥10mm and patients without blood transfusions during hepatic resection. The influence of liver metastases and metastases fiber coated on p rognosis is not a clear conclusion in our article. Recurrence after liver resection is the main problem for GCLM, especially the intrahepatic recurrence, and chemotherapy can reduce the recurrence rate. |
PDF Full Text Request