| Background and ObjectiveGastric cancer is one of the most common malignant tumors,although in recent years its diagnosis and treatment has made great progress,but still did not change its high morbidity and mortality.Gastric cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death in the world.According to the 2014 China Cancer Registration Annual Report,gastric cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death in China.Its prognosis is poor with a 5-year survival rateless than 40%.Gastric cancer with liver metastasis(GCLM)refers to gastric cancer patients through imaging,histological examination or intraoperative exploration found and confirmed in the liver metastatic lesions arising from gastric cancer.Liver is a good site of blood metastasis of gastric cancer,which is closely related to the anatomical structure of the liver and its dual blood supply system,Shitara et al concluded that there were 12,656 patients with advanced gastric cancer in 67 clinical randomized trials,of which the incidence of liver metastases was 44%,the most common metastatic site.The 5-year survival rate of patients with liver metastases from gastric cancer is reported to be no more than 10%.In the absence of active treatment,median survival is only 3-5 months.Liver metastasis from gastric cancer is the terminal stage of gastric cancer development,is one of the leading causes of cancer-related death.At present,systemic chemotherapy,surgical resection,local interventional therapy and ablation therapy are used in the treatment of liver metastases from gastric cancer,but there is no uniform treatment,and the prognosis is poor.This study retrospectively analyzed the relationship between prognostic factors and survival in patients with liver metastases,providing a basis for clinical prognosis and treatment options for GCLM.Materials and MethodsThe Clinical data of 64 patients with hepatic metastases from gastric cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from May 2011 to August 2014,included age,gender,gastric cancer time,primary tumor differentiation,serum albumin level,Liver metastasis time,whether with extrahepatic metastasis,the number of liver metastases,with or without systemic chemotherapy,with or without liver local treatment.The median age was 60 years(17-78 years),11 males and 53 females,of which 49 cases of livermetastases occurred simutaneously,15 patients with ectopic liver metastases,liver metastases: H1(metastases were limited to one of the lobes)20 cases,H2(there were a few scattered metastases in both lobes)16 cases,H3(there were numerous scattered metastases)28 cases.64 cases of gastric cancer were diagnosed by pathology,liver metastasis are conformed by imaging(such as abdominal CT,liver magnetic resonance or PET-CT),each patient received a follow-up every 3-6 months 1 follow-up.At present,the definition of simultaneous and heterogeneous liver metastases is still controversial.According to the previous literature,Hwang et al.defined simultaneous liver metastases for early gastric cancer or liver metastases during surgery,or liver metastases within 1 year after gastric cancer,and to exclude other lesions transferred to the liver,and heterotopic liver metastases after radical resection of gastric cancer(1 to 2 years after radical surgery)and liver metastases without radical gastrectomy.Clinical data of 64 patients with liver metastases from gastric cancer were analyzed by statiatical software spss 21.0,Kaplan--Meier analysis was used to estimate the overall survival and Cox proportional-hazards regression module was employed to analyze the prognostic factors.Results1.4 of the 64 patients with hepatic metastases from gastric cancer were lost during follow-up,the median overall survival time was 10 months and 1-,2-year survival rates were 46.9%,and 23.3%.The median survival time was 5 months for 21 patients who received palliative care and the median survival time was 10.9 months for 35 patients receiving systemic chemotherapy.The median survival time was 8 months for patients receiving systemic chemotherapy + topical treatment(hepatectomy,local chemotherapy,interventional therapy,and ablation).2.The univariate analysis showed that the pathologic characteristics of primary tumor differentiation,the number of liver metastases,whether to receive systemic chemotherapy and the serum albumin level were correlated with the prognosis of patients with hepatic metastases from gastric cancer(P<0.05),while age,gender,liver metastasis time,whether with extrahepatic metastasis,with or without liver local treatment were not(P>0.05).3.The multivariate analysis showed that the primary tumor differentiation and the number of liver metastases were independent factors influencing the prognosis of patients with hepatic metastases from gastric cancer(P<0.05).Conclusion1.The primary tumor differentiation and the number of liver metastases were independent factors influencing the prognosis of patients with hepatic metastases from gastric cancer,the degree of tumor differentiation and liver metastases were more severe and the worse prognosis.2.Systemic chemotherapy compared to BSC can improve overall survival time in patients with liver metastases obviously(P<0.05). |
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