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Su R, Sun X, Chen S, Deng G, Yin S, He Y, Hao T, Gu L, Zhang C. Development and validation of a nomogram to predict the survival and estimate surgical benefits for gastric cancer with liver metastasis receiving primary tumor resection. Front Oncol 2024; 14:1418548. [PMID: 39582532 PMCID: PMC11581971 DOI: 10.3389/fonc.2024.1418548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 10/14/2024] [Indexed: 11/26/2024] Open
Abstract
Background Surgical treatment has been widely controversial for gastric cancer accompanied by liver metastasis (GCLM). This paper aims to develop and validate a nomogram to predict the survival and estimate surgical benefits for GCLM patients. Methods A total of 616 GCLM patients from the Surveillance, Epidemiology, and End Results Program (SEER) database and 74 GCLM patients receiving primary tumor resection (PTR) from the Chinese center were included in this study. Patients from the SEER database were divided into training set (with PTR) (n=493) and non-operative set (without PTR) (n=123). Patients undergoing PTR from China were included as external validation set. Independent risk factors associated with the overall survival of GCLM patients undergoing PTR were identified in the training set via log-rank test and Cox regression analysis. Afterwards, a comprehensive model and corresponding nomogram were constructed and validated by validation set. Results The survival of patients undergoing PTR (n=493) was longer than that without PTR (n=123) (log-rank test, p<0.0001) in SEER cohort. T stage (HR=1.40, 95% CI=1.14, 1.73), differentiation grade (HR=1.47, 95% CI=1.17, 1.85), non-hepatic metastases (HR=1.69, 95% CI=1.29, 2.21), and adjuvant therapy (HR=0.34, 95% CI= 0.28, 0.42) were closely related with the survival of GCLM with PTR, and thus, a four-factor nomogram was established. However, GCLM patients receiving PTR in the high-risk subgroup (n=255) screened out by the nomogram did not have better survival outcomes compared with patients without PTR (n=123) (log-rank test, p=0.25). Conclusions The nomogram could predict survival of GCLM patients receiving PTR with acceptable accuracy. In addition, although PTR did improve the survival of whole GCLM patients, patients in the high-risk subgroup were unable to benefit from PTR, which could assist clinicians to make decisions for the treatment of GCLM.
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Affiliation(s)
- Rishun Su
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xuezeng Sun
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Songyao Chen
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Guofei Deng
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Songcheng Yin
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yulong He
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tengfei Hao
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Liang Gu
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Changhua Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Takahashi K, Terashima M, Notsu A, Koseki Y, Furukawa K, Fujiya K, Tanizawa Y, Bando E. Surgical treatment for liver metastasis from gastric cancer: A systematic review and meta-analysis of long-term outcomes and prognostic factors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108582. [PMID: 39126987 DOI: 10.1016/j.ejso.2024.108582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 07/18/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Chemotherapy is the mainstay treatment for liver metastasis from gastric cancer. However, some retrospective studies and meta-analyses have indicated the efficacy of hepatectomy, which is an aggressive treatment option. However, the optimal selection criteria for hepatectomy and the role of perioperative chemotherapy remain unclear. Therefore, a meta-analysis of studies on hepatectomy was performed to assess the impact of various factors on overall survival (OS). A systematic review was conducted in accordance with the PRISMA criteria using studies published until 2022. The primary outcome was the hazard ratio (HR) for OS. Comparisons were made between hepatectomy and nonhepatectomy, solitary and multiple metastases, synchronous and metachronous metastases, treatment with and without neoadjuvant chemotherapy, and treatment with and without adjuvant chemotherapy. A total of 50 studies involving 1966 patients who underwent hepatectomy were included in the analysis. The meta-analysis showed a 5-year OS rate of 25 %. A meta-analysis comparing hepatectomy with nonhepatectomy showed an HR of 0.2 for hepatectomy. A meta-analysis comparing solitary and multiple metastases showed a trend toward better OS in patients with solitary metastases (odds ratio [OR]: 0.35). A meta-analysis comparing synchronous and metachronous metastases showed favorable OS for patients with metachronous metastases (OR: 0.66). A meta-analysis comparing neoadjuvant chemotherapy with no neoadjuvant chemotherapy showed no difference in OS. In contrast, a meta-analysis comparing adjuvant chemotherapy with no adjuvant chemotherapy showed better OS for adjuvant chemotherapy (OR: 0.39). This retrospective study indicates that hepatectomy may benefit patients with liver metastases from gastric cancer, particularly those with solitary and metachronous metastases.
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Affiliation(s)
| | | | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Japan
| | - Yusuke Koseki
- Division of Gastric Surgery, Shizuoka Cancer Center, Japan
| | | | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, Japan
| | | | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Japan
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Zhao GS, Song YX, Sun JB, Liu S, Xu F, Ma J, Li C, Gao F, Zhou J, Wang RY, Liang SN. Efficacy and safety of CalliSpheres® microspheres drug-eluting beads transarterial chemoembolization in GCLM combined trans-arterial infusion therapy for treating primary focus of gastric cancer: a multi-center retrospective study. Expert Rev Anticancer Ther 2023; 23:1009-1016. [PMID: 37475534 DOI: 10.1080/14737140.2023.2239496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The purpose of this study was to observe the safety and efficacy of CalliSpheres microspheres drug-eluting beads (DEB) transhepatic arterial chemoembolization (CSM-TACE) for liver metastasis of gastric cancer (GCLM) combined with trans-arterial infusion therapy (TAIT) as the primary focus of gastric cancer. RESEARCH DESIGN AND METHODS Unresectable advanced GCLM patients were collected for retrospective analysis. Patients who progressed after chemotherapy or could not receive systematic chemotherapy were selected. CSM-TACE was used for GCLM treatment and oxaliplatin for TAIT of primary focus of gastric cancer. Adverse reactions, tumor reactions, survival rate, and survival time during treatment were recorded, and prognostic factors were analyzed. RESULTS Forty-three patients from four oncology centers met inclusion criteria and were enrolled. CSM-TACE averaged (1.51 ± 0.51) times and TAIT averaged (4.58 ± 1.65) times. The follow-up time was 2.5-49 months, and the 6-month, 1-year, and 2-year survival rates were 86.0%, 72.1%, and 41.9%, respectively, with a median overall survival of 11.5 months. The adverse reactions during treatment were grade 1-3. The hazard ratio (HR) of combination therapy was 0.51 (P = 0.040), and the HR of TAIT frequency was 0.34 (P = 0.002), which were independent protective factors affecting prognosis. CONCLUSIONS CSM-TAC for GCLM combined with TAIT for primary focus of gastric cancer is safe and efficacious, which is worthy of clinical promotion and application.
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Affiliation(s)
- Guang Sheng Zhao
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Yu Xin Song
- Department of Intervention, Chifeng Municipal Hospital, Chifeng, Mongolia Autonomous Region, China
| | - Jin Bo Sun
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Song Liu
- Cancer Interventional Center, Linyi Cancer Hospital, Linyi, Shandong Province, China
| | - Fang Xu
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Jian Ma
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Chuang Li
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Fei Gao
- Cancer Interventional Center, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Jun Zhou
- Cancer Interventional Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Ruo Yu Wang
- Department of Cancer Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Song Nian Liang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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Lin G, Liu Z, Shang‐Guan Z, Zeng G, Lin J, Wu J, Chen Q, Xie J, Li P, Huang C, Zheng C. Comparison of the efficacy between immunochemotherapy and chemotherapy in gastric cancer accompanied with synchronous liver metastases: A real-world retrospective study. Cancer Med 2023; 12:12221-12233. [PMID: 37062073 PMCID: PMC10278523 DOI: 10.1002/cam4.5917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Few studies have investigated the efficacy of comprehensive therapies, including immunotherapy, for gastric cancer with synchronous liver metastases (GCLM). We retrospectively compared the effect of immunochemotherapy and chemotherapy alone as conversion therapies on the oncological outcomes of patients with GCLM. METHODS The clinicopathological data of 100 patients with GCLM from February 2017 to October 2021 at our institution were retrospectively analyzed. Patients were divided into immunochemotherapy (n = 33) and chemotherapy-alone (n = 67) groups. RESULTS Baseline clinicopathological data did not differ significantly between the two groups. The immunochemotherapy group had a higher overall response rate (59.4% vs. 44.0%, p = 0.029) and disease control rate (71.9% vs. 49.2%, p = 0.036) than the chemotherapy group. The immunochemotherapy group showed better tumor regression in the gastric mass, metastatic lymph nodes, and liver lesions than the chemotherapy group. Ten (30.3%) patients in the immunochemotherapy group and 13 (19.4%) patients in the chemotherapy group underwent surgery after conversion therapy. However, the difference was not statistically significant. The overall survival (OS) and progression-free survival (PFS) rates were better in the immunochemotherapy group than in the chemotherapy group. Treatment-related adverse events occurred in 24 (72.7%) and 47 (70.1%) patients in the immunochemotherapy and chemotherapy groups, respectively. CONCLUSIONS As a conversion therapy for GCLM, immunotherapy yielded better primary and metastatic tumor regression and survival benefits, with no increase in adverse events compared to chemotherapy.
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Affiliation(s)
- Guang‐Tan Lin
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Zhi‐Yu Liu
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Zhi‐Xin Shang‐Guan
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Gui‐Rong Zeng
- Fujian Medical University Diagnostic Pathology CenterFujian Medical UniversityFuzhouChina
| | - Jian‐Xian Lin
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
| | - Ju Wu
- Department of General SurgeryAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Qi‐Yue Chen
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Jian‐Wei Xie
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Ping Li
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
| | - Chang‐Ming Huang
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
| | - Chao‐Hui Zheng
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
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Conde Monroy D, Ibañez-Pinilla M, Sabogal JC, Rey Chaves C, Isaza-Restrepo A, Girón F, Vanegas M, Ibañez-Villalba R, Mirow L, Siepmann T. Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020704. [PMID: 36675632 PMCID: PMC9861719 DOI: 10.3390/jcm12020704] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment.
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Affiliation(s)
- Danny Conde Monroy
- Department of Surgery, Hospital Universitario Mayor—Méderi, Bogota 110111, Colombia
- Department of Surgery, Faculty of Medicine, Universidad del Rosario, Bogota 111221, Colombia
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Correspondence:
| | - Milciades Ibañez-Pinilla
- Department of Surgery, Hospital Universitario Mayor—Méderi, Bogota 110111, Colombia
- Department of Surgery, Faculty of Medicine, Universidad del Rosario, Bogota 111221, Colombia
- Faculty of Medicine, Fundación Universitaria Sanitas, Bogota 110131, Colombia
| | - Juan Carlos Sabogal
- Department of Surgery, Hospital Universitario Mayor—Méderi, Bogota 110111, Colombia
| | - Carlos Rey Chaves
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Andrés Isaza-Restrepo
- Department of Surgery, Hospital Universitario Mayor—Méderi, Bogota 110111, Colombia
- Department of Surgery, Faculty of Medicine, Universidad del Rosario, Bogota 111221, Colombia
| | - Felipe Girón
- Department of Surgery, Faculty of Medicine, Universidad del Rosario, Bogota 111221, Colombia
| | - Marco Vanegas
- Department of Surgery, Faculty of Medicine, Universidad del Rosario, Bogota 111221, Colombia
| | | | - Lutz Mirow
- Department of Surgery, Klinikum Chemnitz gGmbH, Medical Campus Chemnitz, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 09116 Chemnitz, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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Li M, Yang B. Long-term outcomes after different treatments for gastric cancer with synchronous liver metastasis: A PRISMA systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e29533. [PMID: 35758396 PMCID: PMC9276347 DOI: 10.1097/md.0000000000029533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The treatment of gastric cancer (GC) with synchronous liver metastasis is still controversial. This systematic review and network meta-analysis was designed to evaluate the long-term outcomes after different treatments of GC with synchronous liver metastasis. METHODS Several electronic databases were searched to identify eligible studies updated on May 1, 2021. Studies assessing the overall survival (OS) after different treatments (including chemotherapy, interventional therapy, surgical therapy alone and adjunctive therapy after surgery) of GC with synchronous liver metastasis were included. Odds ratios with 95% confidence interval (CI) were calculated for survival variables. RESULTS A total of 15 studies including 4312 patients were included in this network meta-analysis. Adjunctive therapy after surgery performed better than surgery therapy alone (hazard ratio [HR] = 1.23, 95% credible interval [CrI]: 0.69-2.17), chemotherapy (HR = 1.18, 95%CrI: 0.71-1.95), and interventional therapy in terms of 1-year OS (HR = 2.03, 95%CrI: 1.22-3.37). In terms of 3-OS, adjunctive therapy after surgery showed better efficacy than surgery therapy alone (HR = 1.48, 95%CrI: 0.40-5.47), chemotherapy (HR = 1.27, 95%CrI: 0.37-4.35), and interventional therapy (HR = 3.16, 95%CrI: 0.73-13.63). For 5-OS, adjunctive therapy after surgery was superior to surgery therapy alone (HR = 1.74, 95%CrI: 0.08-37.76), chemotherapy (HR = 1.44, 95%CrI: 0.66-3.14), and interventional therapy (HR = 1.46, 95%CrI: 0.06-34.36). There were no statistical inconsistency and small-study effect existed in our network meta-analysis for 1-year, 3-year, or 5-year OS. Cluster ranking analysis performed with surface under the cumulative ranking showed adjuvant therapies after surgery (99.9, 96.7, 90.2) ranking higher than surgery therapy alone, chemotherapy, and interventional therapy for 1-year, 3-year, 5-year OS. CONCLUSION The OS of adjuvant therapy after surgery was better than that of surgery therapy alone, chemotherapy, and interventional therapy. Adjuvant therapy after surgery is the most recommended therapy for people with GC with synchronous liver metastasis.
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Affiliation(s)
- Minghui Li
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, PR China
| | - Bin Yang
- Department of General Surgery, 967 Hospital of the Joint Service Support Force of PLA, Dalian, PR China
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Kroese TE, van Laarhoven HWM, Nilsson M, Lordick F, Guckenberger M, Ruurda JP, D'Ugo D, Haustermans K, van Cutsem E, van Hillegersberg R, van Rossum PSN. Definition of oligometastatic esophagogastric cancer and impact of local oligometastasis-directed treatment: A systematic review and meta-analysis. Eur J Cancer 2022; 166:254-269. [PMID: 35339868 DOI: 10.1016/j.ejca.2022.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival (OS). The primary aim was to identify definitions of esophagogastric OMD. A secondary aim was to perform a meta-analysis of OS after local treatment versus systemic therapy alone for OMD. METHODS Studies and study protocols reporting on definitions or OS after local treatment for esophagogastric OMD were included. The primary outcome was the maximum number of organs/lesions considered OMD and the maximum number of lesions per organ (i.e. 'organ-specific' OMD burden). Agreement was considered to be either absent/poor (< 50%), fair (50%-75%), or consensus (≥ 75%). The secondary outcome was the pooled adjusted hazard ratio (aHR) for OS after local treatment versus systemic therapy alone. The ROBINS tool was used for quality assessment. RESULTS A total of 97 studies, including 7 study protocols, and 2 prospective studies, were included. OMD was considered in 1 organ with ≤ 3 metastases (consensus). 'Organ-specific' OMD burden could involve bilobar ≤ 3 liver metastases, unilateral ≤ 2 lung metastases, 1 extra-regional lymph node station, ≤ 2 brain metastases, or bilateral adrenal gland metastases (consensus). Local treatment for OMD was associated with improved OS compared with systemic therapy alone based on 6 non-randomized studies (pooled aHR 0.47, 95% CI: 0.30-0.74) and for liver oligometastases based on 5 non-randomized studies (pooled aHR 0.39, 95% CI: 0.22-0.59). All studies scored serious risk of bias. CONCLUSIONS Current literature considers esophagogastric cancer spread limited to 1 organ with ≤ 3 metastases or 1 extra-regional lymph node station to be OMD. Local treatment for OMD appeared associated with improved OS compared with systemic therapy alone. Prospective randomized trials are warranted.
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Affiliation(s)
- Tiuri E Kroese
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Florian Lordick
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Kroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, et alKroese TE, van Hillegersberg R, Schoppmann S, Deseyne PR, Nafteux P, Obermannova R, Nordsmark M, Pfeiffer P, Hawkings MA, Smyth E, Markar S, Hanna GB, Cheong E, Chaudry A, Elme A, Adenis A, Piessen G, Gani C, Bruns CJ, Moehler M, Liakakos T, Reynolds J, Morganti A, Rosati R, Castoro C, D'Ugo D, Roviello F, Bencivenga M, de Manzoni G, Jeene P, van Sandick JW, Muijs C, Slingerland M, Nieuwenhuijzen G, Wijnhoven B, Beerepoot LV, Kolodziejczyk P, Polkowski WP, Alsina M, Pera M, Kanonnikoff TF, Nilsson M, Guckenberger M, Monig S, Wagner D, Wyrwicz L, Berbee M, Gockel I, Lordick F, Griffiths EA, Verheij M, van Rossum PS, van Laarhoven HW, Rosman C, Rütten H, Gootjes EC, Vonken FE, van Dieren JM, Vollebergh MA, van der Sangen M, Creemers GJ, Zander T, Schlößer H, Cascinu S, Mazza E, Nicoletti R, Damascelli A, Slim N, Passoni P, Cossu A, Puccetti F, Barbieri L, Fanti L, Azzolini F, Ventoruzzo F, Szczepanik A, Visa L, Reig A, Roques T, Harrison M, Ciseł B, Pikuła A, Skórzewska M, Vanommeslaeghe H, Van Daele E, Pattyn P, Geboes K, Callebout E, Ribeiro S, van Duijvendijk P, Tromp C, Sosef M, Warmerdam F, Heisterkamp J, Heisterkamp J, Vera A, Jordá E, López-Mozos F, Fernandez-Moreno MC, Barrios-Carvajal M, Huerta M, de Steur W, Lips I, Diez M, Castro S, O'Neill R, Holyoake D, Hacker U, Denecke T, Kuhnt T, Hoffmeister A, Kluge R, Bostel T, Grimminger P, Jedlička V, Křístek J, Pospíšil P, Mourregot A, Maurin C, Starling N, Chong I. Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe. Eur J Cancer 2022; 164:18-29. [DOI: 10.1016/j.ejca.2021.11.032] [Show More Authors] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/28/2021] [Indexed: 12/17/2022]
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Sun M, Ding H, Zhu Z, Wang S, Gu X, Xia L, Li T. Identifying Optimal Surgical Intervention-Based Chemotherapy for Gastric Cancer Patients With Liver Metastases. Front Oncol 2021; 11:675870. [PMID: 34912701 PMCID: PMC8666972 DOI: 10.3389/fonc.2021.675870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aimed at evaluating the effects of surgical treatments-based chemotherapy in the treatment of gastric cancer with liver metastases (GCLM). It has not been established whether Liver-directed treatment (LDT) options such as hepatectomy and gastrectomy plus chemotherapy (HGCT), radiofrequency ablation and gastrectomy plus chemotherapy (RFAG), transarterial chemoembolization and gastrectomy plus chemotherapy (TACEG), gastrectomy plus chemotherapy (GCT) enhance the survival of GCLM patients. METHODS We performed systematic literature searches in PubMed, EMBASE, and Cochrane library from inception to September 2021. We created a network plot to comprehensively analyze the direct and indirect evidence, based on a frequentist method. A contribution plot was used to determine inconsistencies, a forest plot was used to evaluate therapeutic effects, the publication bias was controlled by funnel plot, while the value of surface under the cumulative ranking curves (SUCRA) was calculated to estimate rank probability. RESULTS A total of 23 retrospective studies were identified, involving 5472 GCLM patients. For OS and 1-, 2-, 3-year survival rate of all trials, meta-analysis of the direct comparisons showed significant better for HGCT treatments compared with GCT or PCT. In the comparison of the 5 treatments for 1-, 2-, 3-year survival rate, HGCT and RFAG were found to be more effective than GCT and PCT, respectively. By OS and 2-, 3-year survival rate analysis, RFAG was identified as the best option, followed by HGCT, TACEG, GCT and PCT. By 1-year survival rate analysis, HGCT and RFAG were identified as the most effective options. CONCLUSION HGCT and RFAG has remarkable survival benefits for GCLM patients when compared to TACEG, GCT and PCT. HGCT was found to exhibit superior therapeutic effects for GCLM patients for 1-year survival rate while RFAG was found to be a prospective therapeutic alternative for OS and 2-, 3-year survival rate. SYSTEMATIC REVIEW REGISTRATION identifier [10.37766/inplasy2020.12.0009].
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Affiliation(s)
- Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Department of Anesthesiology, Institute of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- Hubei Key Laboratory of Embryonic Stem Cell Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hangliang Ding
- Department of General Surgery, Xinchang Hospital Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Zhiqiang Zhu
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shengsheng Wang
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xinsheng Gu
- College of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Lingyun Xia
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Tian Li
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- School of Basic Medicine, Fourth Military Medical University, Xi’an, China
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10
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Granieri S, Altomare M, Bruno F, Paleino S, Bonomi A, Germini A, Facciorusso A, Fagnani D, Bovo G, Cotsoglou C. Surgical treatment of gastric cancer liver metastases: Systematic review and meta-analysis of long-term outcomes and prognostic factors. Crit Rev Oncol Hematol 2021; 163:103313. [PMID: 34044098 DOI: 10.1016/j.critrevonc.2021.103313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
The prognosis of patients with metastatic gastric cancer remains dismal, with palliative treatment as standard of care. However, encouraging results have been reported for surgical resection of liver only metastatic gastric cancer in carefully selected patients. A systematic review of articles published from 2000 onwards was conducted according to PRISMA guidelines. Twenty-nine studies were included in qualitative and quantitative analysis. Meta-analysis of proportions pointed out 29.1 % 5ySR (I 2 = 39 %). The pooled weighted median of MSTs was 31.1 months. T stage > 2, metastasis greatest dimension ≥ 5 cm, the presence of multiple metastases and bilobar disease resulted among the strongest predictors of mortality. Funnel plots, Egger's tests, and P-curve analyses failed to show significant publication bias. Based on strict selection criteria and robust statistical analyses, our results show that, in very carefully selected patients without extrahepatic disease, surgical resection with curative intent may significantly improve overall survival.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Michele Altomare
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; Gastrointestinal, Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Federica Bruno
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Sissi Paleino
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Alessandro Germini
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Daniele Fagnani
- Medical Oncology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Giorgio Bovo
- Pathology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Christian Cotsoglou
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
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Marte G, Tufo A, Steccanella F, Marra E, Federico P, Petrillo A, Maida P. Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors. J Clin Med 2021; 10:jcm10051141. [PMID: 33803135 PMCID: PMC7963158 DOI: 10.3390/jcm10051141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. METHODS The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. RESULTS We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1-2 and pN0-1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. CONCLUSION In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.
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Affiliation(s)
- Gianpaolo Marte
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
- Correspondence: ; Tel.: +39-08118775110
| | - Andrea Tufo
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Francesca Steccanella
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Ester Marra
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
| | - Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (P.F.); (A.P.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (P.F.); (A.P.)
| | - Pietro Maida
- Department of General Surgery, Ospedale del Mare, 80147 Naples, Italy; (A.T.); (F.S.); (E.M.); (P.M.)
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12
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Uggeri F, Ripamonti L, Pinotti E, Scotti MA, Famularo S, Garancini M, Gianotti L, Braga M, Romano F. Is there a role for treatment-oriented surgery in liver metastases from gastric cancer? World J Clin Oncol 2020; 11:477-494. [PMID: 32821653 PMCID: PMC7407929 DOI: 10.5306/wjco.v11.i7.477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distant metastases are found in approximately 35% of patients with gastric cancer at their first clinical observation, and of these, 4%-14% involves the liver. Unfortunately, only 0.4%-2.3% of patients with metastatic gastric cancer are eligible for radical surgery. Although surgical resection for gastric cancer metastases is still debated, there have been changes in recent years, although several clinical issues remain to be defined and that must be taken into account before surgery is proposed.
AIM To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric cancer.
METHODS We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The study protocol was based on identifying studies with clearly defined purpose, eligibility criteria, methodological analysis, and patient outcome.
RESULTS We selected 47 studies pertaining to the purpose of the review, which involved a total of 2304 patients. Median survival was 7-52.3 mo, median disease-free survival was 4.7-18 mo. The 1-, 2-, 3-, and 5-year overall survival (OS) was 33%-90.1%, 10%-60%, 6%-70.4%, and 0%-40.1%, respectively. Only five papers reported the 10-year OS, which was 5.5%–31.5%. The general recurrence rate was between 55.5% and 96%, and that for hepatic recurrence was between 15% and 94%.
CONCLUSION Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis, while the presence of single metastasis or ≤ 3 metastases associated with a size of < 5 cm may be considered data that do not contraindicate liver resection.
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Affiliation(s)
- Fabio Uggeri
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Lorenzo Ripamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Enrico Pinotti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | | | - Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | | | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
| | - Fabrizio Romano
- School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza 20900, Italy
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13
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Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol 2020; 12:1758835920904803. [PMID: 32127925 PMCID: PMC7036491 DOI: 10.1177/1758835920904803] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM. Methods We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus. Results A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful. Conclusions The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.
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Affiliation(s)
- Kecheng Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
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14
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Ito D, Kawaguchi Y, Yamashita H, Arita J, Akamatsu N, Kaneko J, Sakamoto Y, Kokudo N, Seto Y, Hasegawa K. Intestinal-type histology is associated with better prognosis in patients undergoing liver resection for gastric/esophagogastric-junction liver metastasis. Glob Health Med 2019; 1:101-109. [PMID: 33330763 DOI: 10.35772/ghm.2019.01012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022]
Abstract
The indication for resection of gastric/esophagogastric-junction liver metastasis (GELM) has yet to be established. This study aimed to investigate prognostic factors in patients undergoing GELM resection. From 2001 to 2015, 31 consecutive patients underwent resection for GELM; and factors for poor prognosis were evaluated. Of the 31 patients, 23 (74.2%) developed multiple liver metastases. The histology of gastric cancer was intestinal-type adenocarcinoma in 21 patients (67.7%). Median overall survival (OS) was 3.2 years. The 1-, 3-, and 5-year OS rates were 92.8%, 56.2%, and 42.2%, respectively. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 58.5%, 31.3%, and 31.3%, respectively. Multivariate analysis indicated that intestinal-type adenocarcinoma was associated with a significantly lower risk of OS (hazard ratio [HR], 0.26; p =0.022) and RFS (HR, 0.25; p = 0.008). In multiple logistic regression analysis, intestinal-type adenocarcinoma (odds ratio, 0.14; p = 0.012) reduced incidence of extra-hepatic recurrence after GELM resection. In conclusion, GELM resection in patients with intestinal-type histology is preferable because intestinal-type adenocarcinoma is associated with better prognosis and a lower incidence of extra-hepatic recurrence than diffuse/other-type adenocarcinoma.
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Affiliation(s)
- Daisuke Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Gastrointestinal Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Seto
- Gastrointestinal Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Gastrointestinal Surgery Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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15
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Luo Z, Rong Z, Huang C. Surgery Strategies for Gastric Cancer With Liver Metastasis. Front Oncol 2019; 9:1353. [PMID: 31921626 PMCID: PMC6915096 DOI: 10.3389/fonc.2019.01353] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023] Open
Abstract
Gastric cancer with liver metastasis is defined as advanced gastric cancer and remains one of the deadliest diseases with poor prognosis. Approximately 4–14% of patients with gastric cancers presented with liver metastases at the initial diagnosis. Owing to its incurability, first-line treatment for gastric cancer with liver metastases is systematic chemotherapy, whereas surgery is usually performed to alleviate severe gastrointestinal symptoms. However, continuously emerging retrospective studies confirmed the role of surgery in gastric cancer with liver metastases and showed significantly improved survival rate in patients assigned to a group of surgery with or without chemotherapy. Therefore, more and more convincing data that resulted from prospective randomized clinical trials is in need to clarify the surgery strategies in patients with gastric cancer with liver metastasis.
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Affiliation(s)
- Zai Luo
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zeyin Rong
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Huang
- Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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16
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Gavriilidis P, Roberts KJ, de’Angelis N, Sutcliffe RP. Gastrectomy Alone or in Combination With Hepatic Resection in the Management of Liver Metastases From Gastric Cancer: A Systematic Review Using an Updated and Cumulative Meta-Analysis. J Clin Med Res 2019; 11:600-608. [PMID: 31413772 PMCID: PMC6681857 DOI: 10.14740/jocmr3925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated that hepatectomy in patients with synchronous hepatic gastric metastases may improve survival in certain patients. This study aimed to evaluate survival benefits of gastrectomy plus hepatectomy versus gastrectomy alone in patients with hepatic gastric metastases. METHODS Studies were identified by a systematic search of Embase, PubMed, Cochrane Library, and Google Scholar databases. Traditional and cumulative meta-analyses were used to monitor the evidence over time. RESULTS Eleven studies which included 861 patients compared gastrectomy plus hepatic resection in 349 patients with gastrectomy alone in 512 patients. Overall significantly better survival rates of 1, 2, 3, and 5 years were demonstrated for patients who underwent gastrectomy plus hepatic resection compared to patients who under underwent gastrectomy alone ((hazard ratio (HR) = 0.52 (0.39, 0.69), P < 0.001), (HR = 0.85 (0.74, 0.97), P = 0.01), (HR = 0.80 (0.72, 0.90), P = 0.003), (HR = 0.83 (0.78, 0.90), P < 0.001), respectively). CONCLUSIONS Carefully selected patients with hepatic gastric metastases may benefit from hepatic resection.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepato-Biliary-Pancreatic and Oesophago-Gastric Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, NHS Foundation Trust, B15 2TH, UK
| | - Keith J. Roberts
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, NHS Foundation Trust, B15 2TH, UK
| | - Nicola de’Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, Creteil 94010, France
| | - Robert P. Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, NHS Foundation Trust, B15 2TH, UK
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17
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Yang LP, Wang ZX, He MM, Jin Y, Ren C, Wang ZQ, Wang FH, Li YH, Wang F, Xu RH. The survival benefit of palliative gastrectomy and/or metastasectomy in gastric cancer patients with synchronous metastasis: a population-based study using propensity score matching and coarsened exact matching. J Cancer 2019; 10:602-610. [PMID: 30719157 PMCID: PMC6360412 DOI: 10.7150/jca.28842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/08/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction: Palliative surgeries were controversial for asymptomatic metastatic gastric cancer (mGC) patients. This study was aimed to evaluate survival benefit of palliative surgeries to gastric and/or metastatic tumors in mGC patients based on U.S population. Materials and Methods: A total of 8345 gastric cancer patients diagnosed with synchronous distal metastasis between 2004 to 2013 from the Surveillance, Epidemiology, and End Results Program (SEER) database were divided into four groups according to surgery strategies: surgeries to both primary and metastatic tumors (SPM), gastrectomy only (GO), metastasectomy only (MO) and no surgery performed (NS). Their clinicopathological characteristics and overall survival (OS) were analyzed before and after propensity score matching (PSM) and coarsened exact matching (CEM). Results: The median OS of SPM and GO patients was both significantly higher than NS patients (11 months vs. 8 months vs. 5 months; P<0.001, respectively) while that of MO was not (6 months vs. 5 months; P= 0.286). In comparisons between surgery strategies, survival benefit was similar between SPM and GO groups (P=0.389) and both showed significantly better survival than MO patients (P<0.001). All surgery strategies were proved to be favorable prognostic factors over non-surgical treatment (Hazard ratio (HR) for SPM: 0.60, P<0.001; HR for GO: 0.62, P<0.001; HR for MO: 0.91, P=0.046). Similar results were obtained after matching by PSM and CEM except that prognostic impact of MO deteriorated. Conclusions: Gastrectomy plus metastasectomy or gastrectomy alone could be adopted as a choice of improving survival in the U.S population. Metastasectomy alone is not generally recommended.
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Affiliation(s)
- Lu-Ping Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zi-Xian Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ming-Ming He
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ying Jin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Chao Ren
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhi-Qiang Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Feng-Hua Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yu-Hong Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Feng Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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18
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Montagnani F, Crivelli F, Aprile G, Vivaldi C, Pecora I, De Vivo R, Clerico MA, Fornaro L. Long-term survival after liver metastasectomy in gastric cancer: Systematic review and meta-analysis of prognostic factors. Cancer Treat Rev 2018; 69:11-20. [PMID: 29860024 DOI: 10.1016/j.ctrv.2018.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the amelioration of systemic therapy, overall survival (OS) of metastatic gastric cancer (GC) patients remains poor. Liver is a common metastatic site and retrospective series suggest a potential OS benefit from hepatectomy, with interesting 5-year (5 y) and 10-year (10 y) OS rates in selected patients. We aim to evaluate the impact of liver resection and related prognostic factors on long-term outcome in this setting. METHODS We searched Pubmed, EMBASE, and Abstracts/posters from international meetings since 1990. Data were extracted from publish papers. Random effects models meta-analyses and meta-regression models were built to assess 5yOS and the impact of different prognostic factor. Heterogeneity was assessed using between study variance, I2 and Cochran's Q. Funnel plot were used to assess small study bias. RESULTS Thirty-three observational studies (for a total of 1304 patients) were included. Our analysis demonstrates a 5yOS rate of 22% (95%CI: 18-26%) and 10yOS rate of 11% (95%CI: 7-18%) among patients undergoing radical hepatectomy. A favorable effect on OS was shown by several factors linked to primary cancer (lower T and N stage, no lympho-vascular or serosal invasion) and burden of hepatic disease (≤3 metastases, unilobar involvement, greatest lesion < 5 cm, negative resection margins). Moreover, lower CEA and CA19.9 levels and post-resection chemotherapy were associated with improved OS. CONCLUSIONS Surgical resection of liver metastases from GC seems associated with a significant chance of 5yOS and 10yOS and compares favourably with results of medical treatment alone. Prospective evaluation of this approach and validation of adequate selection criteria are needed.
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Affiliation(s)
- Francesco Montagnani
- Department of Oncology, Azienda Sanitaria locale di Biella, Ponderano (BI), Italy.
| | | | - Giuseppe Aprile
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | - Caterina Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Irene Pecora
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale San Bortolo, Azienda ULSS8 Berica - Distretto Est, Vicenza, Italy
| | | | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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19
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Kataoka K, Kinoshita T, Moehler M, Mauer M, Shitara K, Wagner AD, Schrauwen S, Yoshikawa T, Roviello F, Tokunaga M, Boku N, Ducreux M, Terashima M, Lordick F. Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG. Gastric Cancer 2017; 20:904-912. [PMID: 28150070 DOI: 10.1007/s10120-017-0696-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
The role of multidisciplinary treatment including surgery for liver metastases from gastric cancer (LMGC) is controversial. Studies to answer this clinical question are increasing in number, but all published data thus far are based on retrospective analyses with limited sample sizes. Thus, the European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Group (GITCG) and the Japan Clinical Oncology Group (JCOG) Stomach Cancer Study Group (SCSG) initiated a collaboration to develop an optimal treatment strategy for LMGC. Before planning a prospective study, a questionnaire was sent out to the network members of both groups in June 2016 to clarify current common practice in each region. Sixty-seven sites from 17 countries in the EORTC network and 55 sites from Japan responded. According to the survey, for patients with resectable LMGC without extrahepatic metastases, preoperative chemotherapy followed by resection of both primary (if still in place) and liver lesions was the preferred option for both the synchronous and the metachronous setting. For patients with unresectable LMGC, most of the sites recommended chemotherapy only. In this article, the detailed results of this survey are reported, shedding light on current community practice, and a joint EORTC-JCOG strategy of investigation is delineated.
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Affiliation(s)
- Kozo Kataoka
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E, Mounier 83/11, 1200, Brussels, Belgium.
| | - Takahiro Kinoshita
- Department of Gastric Surgery Division, National Cancer Center Hospital East, Chiba, Japan
| | - Markus Moehler
- First Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Murielle Mauer
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E, Mounier 83/11, 1200, Brussels, Belgium
| | - Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, National Cancer Center Hospital East, Chiba, Japan
| | | | - Stefanie Schrauwen
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E, Mounier 83/11, 1200, Brussels, Belgium
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Franco Roviello
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival: Systematic Review and Pooled Analysis. Ann Surg 2017; 263:1092-101. [PMID: 26797324 DOI: 10.1097/sla.0000000000001542] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objectives of this systematic review and pooled analysis were to examine long-term survival, morbidity, and mortality following surgical resection of gastric cancer hepatic metastases and to identify prognostic factors that improve survival. BACKGROUND Patients with hepatic metastases from gastric cancer are traditionally treated with palliative chemotherapy. METHODS A systematic literature search was undertaken (1990 to 2015). Publications were included if they studied more than 10 patients undergoing hepatectomy for hepatic metastasis from gastric adenocarcinoma in the absence of peritoneal disease or other distant organ involvement. The primary outcome was the hazard ratio (HR) for overall survival. The influence of liver metastasis related factors; multiple vs single and metachronous vs synchronous upon survival was also assessed. RESULTS The median number of resections for the 39 studies included was 21 (range 10 to 64). Procedures were associated with a median 30-day morbidity of 24% (0% to 47%) and mortality of 0% (0% to 30%). The median 1-year, 3-year, and 5-year survival were 68%, 31%, and 27%, respectively. Survival was improved in Far Eastern compared with Western studies; 1-year (73% vs 59%), 3-year (34% vs 24.5%), and 5-year (27.3% vs 16.5%). Surgical resection of hepatic metastases was associated with a significantly improved overall survival (HR = 0.50; P < 0.001). Meta-analysis confirmed the additional survival benefit of solitary compared with multiple hepatic metastases (odds ratio = 0.31; P = 0.011). CONCLUSIONS The observed improved survival rates following the resection of hepatic metastasis from gastric adenocarcinoma in selected patients merit a prospective study to formally address the survival benefits and the influence on quality of life of such approach.
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21
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Polkowska-Pruszyńska B, Rawicz-Pruszyński K, Ciseł B, Sitarz R, Polkowska G, Krupski W, Polkowski WP. Liver metastases from gastric carcinoma: A Case report and review of the literature. Curr Probl Cancer 2017; 41:222-230. [PMID: 28625333 DOI: 10.1016/j.currproblcancer.2017.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023]
Abstract
Gastric carcinoma (GC) is the fifth most common malignancy worldwide but the third leading cause of cancer death, and surgery remains the only curative treatment option. Prognosis of patients with liver metastases from gastric carcinoma (LMGC) is poor, and the optimal treatment of metastatic gastric cancer remains a matter of debate. In 2002, a 53-year-old male patient with GC and synchronous oligometastatic lesion in liver VIII segment underwent a total gastrectomy combined with metastasectomy. The pathologic diagnosis was stage IV gastric adenocarcinoma (pT3N2M1), which was treated with adjuvant chemotherapy (cisplatin, epirubicin, leucovorin, and 5-fluorouracil). In 2012, abdominal ultrasound and percutaneous liver biopsy revealed recurrence of the metastasis in the right liver lobe. Progression of the disease was observed after palliative chemotherapy (epirubicin, oxaliplatin, and capecitabine). Nevertheless, an extended right hemihepatectomy, with excision of segments 1, 4A, 5, 6, 7, and 8, was still performed. Pathologic examination confirmed large KRAS- and HER2-negative LMGC. The patient is alive and free of disease 47 months after the repeated hepatectomy and 13 years after removal of the primary GC and synchronous liver metastasis. Based on review of 27 articles, 5-year overall survival rate following gastrectomy and liver metastasectomy may reach 60%, with median survival time up to 74 months. Although the combination of aggressive surgical approach with systemic therapy for LMGC is controversial, it may allow favorable outcome. Careful selection of patients based on evaluable predictive factors for R0 surgical resection of both primary tumor and liver metastases can lead to cure, as shown in our case presentation, where a 10-year relapse-free survival was observed, followed by successful repeated hepatectomy due to liver metastases.
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Affiliation(s)
| | | | - Bogumiła Ciseł
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Grażyna Polkowska
- Department of Neonatal and Infant Pathology, Medical University of Lublin, Lublin, Poland
| | - Witold Krupski
- Second Department of Radiology, Medical University of Lublin, Lublin, Poland
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22
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Surgical resection for hepatic metastasis from gastric cancer: a multi- institution study. Oncotarget 2017; 8:71147-71153. [PMID: 29050350 PMCID: PMC5642625 DOI: 10.18632/oncotarget.16705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background The beneficial effect of surgical resection for hepatic metastasis from gastric cancer (HMGC) remains elusive. This study was conducted to analyze surgical outcomes of HMGC and determine the prognostic factors associated with survival. Results The in-hospital mortality rate was zero, and the overall morbidity rate was 56%. The overall 1-, 3-, and 5-year survival rate after surgery was 87.5%, 47.6%, and 21.7%, respectively, with a median survival time of 34.0 months. Multiple liver metastases (hazard ratio [HR] =1.998; 95% confidence interval [CI] = 1.248-3.198; P = 0.004) and ≥ T3 stage of the primary gastric cancer (HR = 2.065; 95% CI = 1.201–3.549; P = 0.009) were independent prognostic determinants in the multivariate analysis. Materials and Methods Data on surgical resection of 96 patients with HMGC at six institutions in China were analysed retrospectively. Prognostic factors were assessed by multiple stepwise regression analysis using the Cox model. Conclusions Surgical resection for HMGC is feasible and beneficial to long-term survival in selected patients.
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Zhou F, Yu XL, Liang P, Cheng Z, Han ZY, Yu J, Liu F, Hu Y. Microwave ablation is effective against liver metastases from gastric adenocarcinoma. Int J Hyperthermia 2017; 33:830-835. [PMID: 28540787 DOI: 10.1080/02656736.2017.1306120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The resection rate for liver metastases from gastric cancer is only 1.4-21.1%. This study aimed to evaluate the safety and therapeutic efficacy of microwave ablation (MWA) for liver metastases from gastric adenocarcinoma (LMGC). MATERIALS AND METHODS A database of 108 gastric adenocarcinoma patients with liver metastases who underwent MWA (n = 32) or systemic chemotherapy (n = 76) for LMGC between 2008 and 2016 was reviewed. Overall survival curves were assessed and compared based on different therapies. RESULTS All the patients were followed up for a median of 15 months (range, 2-68 months). The median cumulative survival times of patients after MWA and systemic chemotherapy were 25 (95% confidence interval (CI) 16.5-33.5) months and 12 (95% CI 7.7-16.3) months, respectively (HR 1.751, 95% CI 1.077-2.845; p = .015). The 1-, 3-, and 5- year survival rates were 80.9%, 31.2%, and 16.7% (MWA group); and 50.0%, 18.8%, and 5.4% (chemotherapy group), respectively. In the MWA group, side effects were reported in eight patients who developed abdominal pain, transient fever, or nausea. Dominant size, number of liver metastases, therapeutic modalities, and presence of extrahepatic metastases showed significant prognostic value in univariate analyses; while the latter three were identified as independent prognostic factors in multivariate regression analysis. CONCLUSIONS MWA is a safe and useful alternative for liver metastases from gastric adenocarcinoma in selected patients.
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Affiliation(s)
- Fubo Zhou
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Xiao-Ling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhi-Yu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Fangyi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Yi Hu
- b Department of Oncology , Chinese PLA General Hospital , Beijing , China
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24
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Liao YY, Peng NF, Long D, Yu PC, Zhang S, Zhong JH, Li LQ. Hepatectomy for liver metastases from gastric cancer: a systematic review. BMC Surg 2017; 17:14. [PMID: 28193210 PMCID: PMC5307809 DOI: 10.1186/s12893-017-0215-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 02/11/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Official guidelines recommend palliative treatments for patients with liver metastases from gastric cancer. However, many case series reported that hepatectomy for such cases is safe and effective. This systematic review compares the overall survival between hepatectomy and palliative therapy in patients with liver metastases from gastric cancer. METHODS Two independent reviewers performed a systematic search of literature in EMBASE and PubMed, updated until 26 October 2016. The Newcastle-Ottawa score for cohort studies was used for quality assessment of included studies. RESULTS A total of eight cohort studies involving 196 patients in the hepatectomy arm and 481 in the palliative arm were included. Median overall survival of patients in the two arms was 23.7 (range, 13.0 to 48.0) and 7.6 (range, 5.5 to 15.2), respectively. Median rates of overall survival of the two arms were 69, 40, 33 and 27, 8, 4% at 1, 2, and 3 years, respectively. Comparing with palliative therapy, hepatectomy was associated with significantly lower mortality at 1 year (odds ratio 0.17, P < 0.001) and 2 years (odds ratio 0.15, P < 0.001). Among the patients who underwent hepatectomy, Asian cohorts showed higher median rates of overall survival than Western cohorts at 1 year (76 vs. 60%), 2 years (47 vs. 30%) and 3 years (39 vs. 23%). CONCLUSIONS Hepatectomy in the management of liver metastases from gastric cancer can be considered effective. In the elective setting, hepatectomy provides a potential alternative to palliative therapy.
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Affiliation(s)
- Ying-Yang Liao
- Nutrition Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Ning-Fu Peng
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Province China
| | - Di Long
- Colorectal Anal Surgery Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 China
| | - Peng-Cheng Yu
- Colorectal Anal Surgery Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 China
| | - Sen Zhang
- Colorectal Anal Surgery Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Province China
| | - Le-Qun Li
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021 Guangxi Province China
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25
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Long D, Yu PC, Huang W, Luo YL, Zhang S. Systematic review of partial hepatic resection to treat hepatic metastases in patients with gastric cancer. Medicine (Baltimore) 2016; 95:e5235. [PMID: 27858875 PMCID: PMC5591123 DOI: 10.1097/md.0000000000005235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine overall survival and mortality following hepatic resection in patients with hepatic metastases from gastric cancer. METHODS EMBASE, PubMed, Web of Science, and Cochrane databases were systematically searched for publications involving more than 10 patients who underwent hepatic resection to treat hepatic metastases from gastric cancer and who did not have peritoneal disease or involvement of other distant organs. RESULTS A total of 39 studies were included, involving a median of 21 hepatic resections (range, 10-64). Resection was associated with median 30-day morbidity of 24% (range, 0%-47%) and 30-day mortality of 0% (range, 0%-30%). Median overall survival was 68% at 1 year, 31% at 3 years, and 27% at 5 years. Asian studies reported higher rates than Western studies for overall survival at 1 year (73% vs 59%), 3 years (34% vs 25%), and 5 years (27% vs 17%). Compared with palliative treatment, resection was associated with significantly lower mortality at 1 year (risk ratio [RR] 0.47, P < 0.001) and 2 years (RR 0.70, P < 0.001). CONCLUSION Patients with hepatic metastases from gastric cancer may benefit from hepatic resection in case of good physical condition, absence of peritoneal dialysis, and optimum liver function with single metastases. More trials are needed to confirm this finding.
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Affiliation(s)
- Di Long
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
- Department of General Surgery, The Second People's Hospital of Qinzhou, Qinzhou, China
| | - Peng-Cheng Yu
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Wei Huang
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Yu-Long Luo
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Sen Zhang
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
- Correspondence: Sen Zhang, Department of Colorectal Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Rd #22, Nanning 530021, China (e-mail: )
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26
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Mastoraki A, Benetou C, Mastoraki S, Papanikolaou IS, Danias N, Smyrniotis V, Arkadopoulos N. The role of surgery in the therapeutic approach of gastric cancer liver metastases. Indian J Gastroenterol 2016; 35:331-336. [PMID: 27528456 DOI: 10.1007/s12664-016-0683-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/17/2016] [Indexed: 02/06/2023]
Abstract
Gastric cancer (GC) currently prevails as the second cause of death by malignancy worldwide. Estimations suggest that 35 % of affected patients appear with synchronous distant metastases. The vast majority of patients present with hepatic metastatic disease, sometimes accompanied by synchronous peritoneal and lung dissemination. The disease mostly remains asymptomatic at an early stage, with few reported cases of incidental abdominal discomfort. As the cancer advances, symptoms such as nausea or vomiting arise, along with indigestion and dysphagia, blood loss in the form of melena or hematemesis, as well as anorexia and weight loss. Having spread to the liver, it also causes jaundice due to hepatomegaly and general inanition. Despite recent research on the therapeutic strategies against GC metastatic disease, surgical resection appears the only potentially curative approach. Unfortunately, the majority of patients are not eligible to undergo surgical intervention. With regard to treatment modalities of the advanced stage disease, the role of metastasectomy is still debatable and quite unclear, while prolonged survival was succeeded only under certain specific circumstances. Systemic chemotherapy remains however another option, as well as local management in the form of cryotherapy, radiofrequency ablation, or transcatheter arterial chemoembolization. The aims of this review were to evaluate the results of surgical treatment for metastatic GC with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of advanced surgical management of this entity. Relevant publications in the last two decades are briefly reviewed.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece.
| | - Christina Benetou
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
| | - Sotiria Mastoraki
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
| | - Nikolaos Danias
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
| | - Vassilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, Attikon University Hospital, 1 Rimini Street, 12462, Chaidari, Athens, Greece
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27
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Li MX, Jin ZX, Zhou JG, Ying JM, Liang ZY, Mao XX, Bi XY, Zhao JJ, Li ZY, Huang Z, Zhang YF, Li Y, Chen X, Hu XH, Hu HJ, Zhao DB, Wang YY, Cai JQ, Zhao H. Prognostic Value of Lymph Node Ratio in Patients Receiving Combined Surgical Resection for Gastric Cancer Liver Metastasis: Results from Two National Centers in China. Medicine (Baltimore) 2016; 95:e3395. [PMID: 27100426 PMCID: PMC4845830 DOI: 10.1097/md.0000000000003395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to evaluate the prognostic value of lymph node ratio (LNR) in patients with gastric cancer liver metastasis (GCLM) who received combined surgical resection. A retrospective analysis of 46 patients from two hospitals was conducted. Patients were dichotomized into two groups (high LNR and low LNR) by the median value of LNR. The overall survival (OS) and recurrence-free survival (RFS) were analyzed by the Kaplan-Meier method with the log-rank test. The Cox proportional hazard model was used to carry out the subsequent multivariate analyses. And the relationship between LNR and clinicopathological characteristics was assessed. The cut-off value defining elevated LNR was 0.347. With a median follow-up of 67.5 months, the median OS and RFS of the patients were 17 and 9.5 months, respectively. Six patients survived for >5 years after surgery. Patients with higher LNR had significantly shorter OS and RFS than those with lower LNR. In the multivariate analyses, higher LNR and multiple liver metastatic tumors were identified as the independent prognostic factors for both OS and RFS. Elevated LNR was significantly associated with advanced pN stage (P <0.001), larger primary tumor size (P = 0.046), the presence of microvascular invasion (P = 0.008), and neoadjuvant chemotherapy (P = 0.004). LNR may be prognostic indicator for patients with GCLM treated by synchronous surgical resection. Patients with lower LNR and single liver metastasis may gain more survival benefits from the surgical resection. Further prospective studies with reasonable study design are warranted.
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Affiliation(s)
- Mu-Xing Li
- From the Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 17, Panjiayuan Nanli (M-XL, Z-XJ, J-GZ, X-YB, J-JZ, Z-YL, ZH, Y-FZ, YL, XC, X-HH, H-JH, D-BZ, J-QC, HZ); Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1 ShuaiFuYuan Hutong (Y-YW); Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No.17, Panjiayuan Nanli (J-MY); Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), No. 1 ShuaiFuYuan Hutong (Z-YL, X-XM); and Peking Union Medical College, Chinese Academy of Medical Sciences, No. 5 DongDanSanTiao, Beijing, People's Republic of China (Z-XJ)
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Tiberio GAM, Roviello F, Donini A, de Manzoni G, Cancer TIRGFG. Hepatic metastases from gastric cancer: A surgical perspective. World J Gastroenterol 2015; 21:11489-11492. [PMID: 26556981 PMCID: PMC4631955 DOI: 10.3748/wjg.v21.i41.11489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/09/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Management of patients with hepatic metastases as the sole metastatic site at diagnosis of gastric cancer (synchronous setting) or detected during follow-up (metachronous) is controversial. The prevailing attitude in these cases is passive, leading to surgical palliation and, possibly, to chemotherapy. Authors focused this editorial in order to promote a more pragmatic attitude. They stress the importance of recognizing the good candidates to curative surgery of both gastric cancer and hepatic metastases (synchronous setting) or hepatic disease alone (metachronous disease) from those who will not benefit from surgical therapy. In fact, in adequately selected subgroup of patients surgery, especially if integrated in multimodal therapeutic strategies, may achieve unexpected 5-year survival rates, ranging from 10% to 40%. The critical revision of the literature suggests that some simple clinical criteria exist that may be effectively employed in patients selection. These are mainly related to the gastric cancer (factors T, N, G) and to the extent of hepatic involvement (factor H). Upon these criteria it is possible to adequately select about 50% of cases. In the remaining 50% of cases a critical discussion on a case-by-case basis is recommended, considering that among these patients some potential long-survivors exist, that survival is strictly influenced by the ablation of the tumor bulk and by multimodality treatments including chemotherapy and that in expert institutions this kind of surgery is performed with very low mortality and morbidity rates.
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Surgery for Liver Metastases From Gastric Cancer: A Meta-Analysis of Observational Studies. Medicine (Baltimore) 2015. [PMID: 26252272 DOI: 10.1097/md0000000000001113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of surgical therapy in patients with liver metastases from gastric cancer is still controversial. In this study, we investigated the results obtained with local treatment of hepatic metastases in patients with gastric cancer, by performing a systematic literature review and meta-analysis.We performed a systematic review and meta-analysis of observational studies published between 1990 and 2014. These works included multiple studies that evaluated the different survival rate among patients who underwent local treatment, such as hepatectomy or radiofrequency ablation, for hepatic metastases derived from primary gastric cancer. The collected studies were evaluated for heterogeneity, publication bias, and quality, and a pooled hazard ratio (HR) was calculated with a confidence interval estimated at 95% (95% CI).After conducting a thorough research among all published works, 2337 studies were found and after the review process 11 observational studies were included in the analysis. The total amount of patients considered in the survival analysis was 1010. An accurate analysis of all included studies reported a significantly higher survival rate in the group of patients who underwent the most aggressive local treatment for hepatic metastases (HR 0.54, 95% CI 0.46-0.95) as opposed to patients who underwent only palliation or systemic treatment. Furthermore, palliative local treatment of hepatic metastases had a higher survival rate if compared to surgical (without liver surgery) and systemic palliation (HR 0.50, 95% CI 0.26-0.96). Considering the only 3 studies where data from multivariate analyses was available, we found a higher survival rate in the local treatment groups, but the difference was not significant (HR 0.50, 95% CI 0.22-1.15).Curative and also palliative surgery of liver metastases from gastric cancer may improve patients' survival. However, further trials are needed in order to better understand the role of surgery in this group of patients.
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Martella L, Bertozzi S, Londero AP, Steffan A, De Paoli P, Bertola G. Surgery for Liver Metastases From Gastric Cancer: A Meta-Analysis of Observational Studies. Medicine (Baltimore) 2015; 94:e1113. [PMID: 26252272 PMCID: PMC4616574 DOI: 10.1097/md.0000000000001113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of surgical therapy in patients with liver metastases from gastric cancer is still controversial. In this study, we investigated the results obtained with local treatment of hepatic metastases in patients with gastric cancer, by performing a systematic literature review and meta-analysis.We performed a systematic review and meta-analysis of observational studies published between 1990 and 2014. These works included multiple studies that evaluated the different survival rate among patients who underwent local treatment, such as hepatectomy or radiofrequency ablation, for hepatic metastases derived from primary gastric cancer. The collected studies were evaluated for heterogeneity, publication bias, and quality, and a pooled hazard ratio (HR) was calculated with a confidence interval estimated at 95% (95% CI).After conducting a thorough research among all published works, 2337 studies were found and after the review process 11 observational studies were included in the analysis. The total amount of patients considered in the survival analysis was 1010. An accurate analysis of all included studies reported a significantly higher survival rate in the group of patients who underwent the most aggressive local treatment for hepatic metastases (HR 0.54, 95% CI 0.46-0.95) as opposed to patients who underwent only palliation or systemic treatment. Furthermore, palliative local treatment of hepatic metastases had a higher survival rate if compared to surgical (without liver surgery) and systemic palliation (HR 0.50, 95% CI 0.26-0.96). Considering the only 3 studies where data from multivariate analyses was available, we found a higher survival rate in the local treatment groups, but the difference was not significant (HR 0.50, 95% CI 0.22-1.15).Curative and also palliative surgery of liver metastases from gastric cancer may improve patients' survival. However, further trials are needed in order to better understand the role of surgery in this group of patients.
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Affiliation(s)
- Luca Martella
- From the Surgical Oncology Department, IRCSS CRO, Aviano, Italy (LM, SB, PDP, GB); SOC of Obstetrics and Gynecology, S. Polo Hospital, Monfalcone, Italy (APL); and Oncological Pathology Unit, IRCSS CRO, Aviano, Italy (AS)
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Petrelli F, Coinu A, Cabiddu M, Ghilardi M, Borgonovo K, Lonati V, Barni S. Hepatic resection for gastric cancer liver metastases: A systematic review and meta-analysis. J Surg Oncol 2015; 111:1021-7. [PMID: 26082326 DOI: 10.1002/jso.23920] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/19/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Resection of liver metastases from gastric cancer (GC) is rarely performed, and the outcome after hepatic surgery has not been systematically evaluated in the literature. The aim of this study was to perform a systematic review of outcome and prognostic factors for survival after liver metastasectomy for GC. METHODS We performed a meta-analysis of published studies that focused on long-term outcomes (5-year overall survival [OS]) after surgical management of liver metastases from GC, and included more than 10 patients each. Pooled hazard ratios (HRs) were calculated for variables considered as potential prognostic factors for OS in at least three publications. RESULTS Twenty-three studies comprising a total of 870 patients were considered in this analysis. The pooled weighted median OS was 22 months (95%CI 17.6-27.2). The pooled 5-year OS after liver resection was 23.8% (95%CI 19-29.3%). The pooled 5-year OS rates for metachronous and synchronous metastases were 30% (95%CI 24.7-35.8%) and 22.6% (95%CI 14-34.4%), respectively. Parameters associated with poor survival were (i) multiple metastases, and (ii) large size of metastases. CONCLUSIONS Hepatic resection of GC liver metastases is associated with an acceptable 5-year OS, in particular after surgery of metachronous lesions, and could be offered to selected patients.
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Affiliation(s)
- Fausto Petrelli
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Andrea Coinu
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Mary Cabiddu
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Mara Ghilardi
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Karen Borgonovo
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Veronica Lonati
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
| | - Sandro Barni
- Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy
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