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Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study

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Abstract

Background

The prognosis for patients with liver metastases from gastric cancer is very poor. Nevertheless, standard therapeutic strategies have not been established yet. The impact of hepatic surgical treatment on survival of patients with metachronous liver metastases from gastric cancer still remains controversial.

Methods

We conducted a retrospective analysis on records of 436 patients who received radical gastrectomy (with D2 lymphadenectomy, regardless of hepatic surgical treatment) for gastric cancer with metachronous (≥ 3 months after gastrectomy) liver metastases in our center between 2001 and 2016. All patients were followed until 2017/10/31 or withdrawn from the follow-up because of death.

Results

The median interval for non-hepatic metastases of the 436 patients who underwent radical gastrectomy is 14 months. T (P = 0.041), N (P = 0.023) and lymphovascular invasion (P < 0.001) were independent predictors affecting liver metastases-free interval. The overall survival rates for the 436 patients were 44.5, 29.7, 16.3, and 16.3% at 1, 2, 3, and 5 years respectively since treatment of hepatic metastases, with a median survival time of 11 months. N (P = 0.025), extent of liver metastases (H) (H2 vs. H1, P = 0.036; H3 vs. H1, P < 0.001), and treatment of liver metastatic lesions (P < 0.001) were significant independent prognostic factors for survival after presence of liver metastases. Among H1 and H2 patients, median survival in hepatic surgical treatment group was significantly longer than that in systemic chemotherapy alone group (25 vs. 11 months, P = 0.015).

Conclusions

Liver examinations should be performed during the first 2 years after gastric surgery and continued for 5 years for high-risk patients. Active therapeutic strategies may prolong patients’ survival compared with supportive treatment alone. Patients with H1, H2 metachronous liver metastases may be considered appropriate candidates for hepatic surgical treatment before embarking on systemic chemotherapy alone.

Trial registration

ISRCTN Registry (Retrospectively registered; Reference number: 35067; Date: 02/04/2018).

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Abbreviations

GC:

gastric carcinoma

GCCM:

colorectal metastases from gastric cancer

GCMLM:

gastric cancer with metachronous liver metastases

GCLM:

liver metastases from gastric cancer

TACE:

transcatheter arterial chemoembolization

MCT:

microwave coagulation therapy

MST:

median survival time

References

  1. Thun MJ, DeLancey JO, Center MM, Center MM, Jemal A, Ward EM (2010) The global burden of cancer: priorities for prevention. Carcinogenesis 31:100–110

    Article  CAS  PubMed  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  Google Scholar 

  3. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289

    Article  CAS  PubMed  Google Scholar 

  4. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  PubMed  Google Scholar 

  5. D’Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS (2004) Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 240:808–816

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sakamoto Y, Sano T, Shimada K, Esaki M, Saka M, Fukagawa T et al (2007) Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol 95:534–539

    Article  PubMed  Google Scholar 

  7. Tiberio GA, Coniglio A, Marchet A, Marrelli D, Giacopuzzi S, Baiocchi L et al (2009) Metachronous hepatic metastases from gastric carcinoma: a multicentric survey. Eur J Surg Oncol 35:486–491

    Article  CAS  PubMed  Google Scholar 

  8. Slupski M, Wlodarczyk Z, Jasinski M, Masztalerz M, Tujakowski J (2009) Outcomes of simultaneous and delayed resections of synchronous colorectal liver metastases. Can J Surg 52:E241–E244

    PubMed  PubMed Central  Google Scholar 

  9. Saiura A, Umekita N, Inoue S, Maeshiro T, Miyamoto S, Matsui Y et al (2002) Clinicopathological features and outcome of hepatic resection for liver metastasis from gastric cancer. Hepato-Gastroenterology 49:1062–1065

    PubMed  Google Scholar 

  10. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Fujii S et al (2008) Impact of palliative gastrectomy in patients with incurable advanced gastric cancer. Anticancer Res 28:1309–1315

    PubMed  Google Scholar 

  11. Cheon SH, Rha SY, Jeung HC, Im CK, Kim SH, Kim HR et al (2008) Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol 19:1146–I 153

    Article  CAS  PubMed  Google Scholar 

  12. Sakamoto Y, Ohyama S, Yamamoto J, Yamaka K, Seki M, Ohta K et al (2003) Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery 133:507–511

    Article  PubMed  Google Scholar 

  13. Ajani JA (2005) Evolving chemotherapy for advanced gastric cancer. Oncologist 10(Suppl 3):49–58

    Article  CAS  PubMed  Google Scholar 

  14. Shin A, Kim J, Park S (2011) Gastric cancer epidemiology in Korea. J Gastric Cancer 11:135–140

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li C, Yan M, Chen J, Xiang M, Zhu ZG, Yin HR et al (2010) Survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis. J Gastrointest Surg 14:282–288

    Article  PubMed  Google Scholar 

  16. Zacherl J, Zacherl M, Scheuba C, Steininger R, Wenzl E, Mühlbacher F et al (2002) Analysis of hepatic resection of metastasis originating from gastric adenocarcinoma. J Gastrointest Surg 6:682–689

    Article  PubMed  Google Scholar 

  17. Markar SR, Mikhail S, Malietzis G, Athanasiou T, Mariette C, Sasako M et al (2016) Influence of surgical resection of hepatic metastases from gastric adenocarcinoma on long-term survival: systematic review and pooled analysis. Ann Surg 263:1092–1101

    Article  PubMed  Google Scholar 

  18. Tsujimoto H, Ichikura T, Ono S, Suqasawa H, Hiraki S, Sakamoto N et al (2010) Outcomes for patients following hepatic resection of metastatic tumors from gastric cancer. Hepatol Int 4:406–413

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marrelli D, Roviello F, De Stefano A, Fotia G, Giliberto C, Garosi L et al (2004) Risk factors for liver metastases after curative surgical procedures for gastric cancer: a prospective study of 208 patients treated with surgical resection. J Am Coll Surg 198:51–58

    Article  PubMed  Google Scholar 

  20. Takemura N, Saiura A, Koga R, Arita J, Yoshioka R, Ono Y et al (2012) Long-term outcomes after surgical resection for gastric cancer liver metastasis: an analysis of 64 macroscopically complete resections. Langenbeck's Arch Surg 397:951–957

    Article  Google Scholar 

  21. Kumagai K, Tanaka T, Yamagata K, Yokoyama N, Shimizu K (2001) Liver metastasis in gastric cancer with particular reference to lymphatic advancement. Gastric Cancer 4:150–155

    Article  CAS  PubMed  Google Scholar 

  22. Koga S, Takebayashi M, Kaibara N, Nishidoi H, Kimura O, Kawasumi H et al (1987) Pathological characteristics of gastric cancer that develop hematogenous recurrence, with special reference to the site of recurrence. J Surg Oncol 36:239–242

    Article  CAS  PubMed  Google Scholar 

  23. Maehara Y, Orita H, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D et al (1992) Predictors of lymph node metastasis in early gastric cancer. Br J Surg 79:245–247

    Article  CAS  PubMed  Google Scholar 

  24. Saito H, Tsujitani S, Kondo A, Ikeguchi M, Maeta M, Kaibara N (1999) Expression of vascular endothelial growth factor correlates with hematogenous recurrence in gastric carcinoma. Surgery 125:195–201

    Article  CAS  PubMed  Google Scholar 

  25. Hyung WJ, Lee JH, Choi SH, Min JS, Noh SH (2002) Prognostic impact of lymphatic and/or blood vessel invasion in patients with node-negative advanced gastric cancer. Ann Surg Oncol 9:562–567

    Article  PubMed  Google Scholar 

  26. Dicken BJ, Graham K, Hamilton SM, Andrews S, Lai R, Listgarten J (2006) Lymphovascular invasion is associated with poor survival in gastric cancer: an application of gene-expression and tissue array techniques. Ann Surg 243:64–73

    Article  PubMed  PubMed Central  Google Scholar 

  27. Okano K, Maeba T, Ishimura K, Karasawa Y, Goda F, Wakabayashi H et al (2002) Hepatic resection for metastatic tumors from gastric cancer. Ann Surg 235:86–91

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kwok CM, Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY (2004) Survival of gastric cancer with concomitant liver metastases. Hepato-Gastroenterology 51:1527–1530

    PubMed  Google Scholar 

  29. Lim S, Muhs BE, Marcus SG, Newman E, Berman RS, Hiotis SP (2007) Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol 95:118–122

    Article  PubMed  Google Scholar 

  30. Ueda K, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K et al (2009) Analysis of the prognostic factors and evaluation of surgical treatment for synchronous liver metastases from gastric cancer. Langenbeck's Arch Surg 394:647–653

    Article  Google Scholar 

  31. Saito H, Yamada Y, Tsujitani S, Ikequchi M (2009) Clinicopathologic characteristics of gastric cancer patients who underwent noncurative gastrectomy with long-term survival. Langenbeck's Arch Surg 394:99–103

    Article  Google Scholar 

  32. Morise Z, Sugioka A, Hoshimoto S, Kato T, Ikeda M, Uyama I et al (2008) The role of hepatectomy for patients with liver metastases of gastric cancer. Hepato-Gastroenterology 55:1238–1241

    PubMed  Google Scholar 

  33. Leong T (2005) Chemotherapy and radiotherapy in the management of gastric cancer. Curr Opin Gastroenterol 21:673–678

    Article  PubMed  Google Scholar 

  34. Samarasam I, Chandran BS, Sitaram V, Perakath B, Nair A, Mathew G (2006) Palliative gastrectomy in advanced gastric cancer: is it worthwhile? ANZ J Surg 76:60–63

    Article  PubMed  Google Scholar 

  35. Koga R, Yamamoto J, Ohyama S, Saiura A, Seki M, Seto Y et al (2007) Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol 37:836–842

    Article  PubMed  Google Scholar 

  36. Miyagaki H, Fujitani K, Tsujinaka T, Hirao M, Yasui M, Kashiwazaki M et al (2008) The significance of gastrectomy in advanced gastric cancer patients with non-curative factors. Anticancer Res 28:2379–2384

    CAS  PubMed  Google Scholar 

  37. Hwang SE, Yang DH, Kim CY (2009) Prognostic factors for survival in patients with hepatic recurrence after curative resection of gastric cancer. World J Surg 33:1468–1472

    Article  PubMed  Google Scholar 

  38. Hirasawa T, Asahara S, Fujisaki S, Kuraoka K, Takano K, Kamei A et al (2008) Transcatheter arterial chemoembolization (TACE) using degradable starch microspheres (DSM) for metastatic liver tumors in patients with gastric cancer. Nippon Shokakibyo Gakkai Zasshi 105:367–372

    PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to all doctors at the relevant departments for their clinical practice on the enrolled patients.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China

    Yibin Xiao, Bo Zhang & Yulian Wu

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  1. Yibin Xiao
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  2. Bo Zhang
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  3. Yulian Wu
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Contributions

Yibin Xiao designed the research; Yibin Xiao, Bo Zhang, and Yulian Wu collected and analyzed the data; Yibin Xiao wrote and revised the manuscript; Yulian Wu provided analytic tools and checked the accuracy of the data. All the authors approved the version to be published.

Corresponding author

Correspondence to Yulian Wu.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the ethical committee of the Second Affiliated Hospital, School of Medicine, Zhejiang University. All patients were followed up by phone call or SMS and explained clearly that data collected will be intended for publication. All methods were performed in accordance with the relevant guidelines and regulations.

Competing interests

The authors declare that they have no conflict of interest.

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Xiao, Y., Zhang, B. & Wu, Y. Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study. Ir J Med Sci 188, 415–424 (2019). https://doi.org/10.1007/s11845-018-1864-4

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  • DOI: https://doi.org/10.1007/s11845-018-1864-4

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