手术治疗胃癌肝转移的预后分析

The Analysis of the Prognostic Factors for Hepatic Resection on Gastric Cancer with Liver Metastasis

目的:探讨手术治疗胃癌肝转移的预后因素。方法:对25例患者临床病理特征及生存应用多元分析其与预后的关系。结果:20例行同时性肝切除,5例行异时性肝切除,1、3、5年生存率分别为84.0%,28.0%,21.0%。肝转移灶数目(孤立和多灶),转移灶分布(单叶和多叶),肝切除方式,原发灶组织学类型,淋巴结转移及脉管瘤栓与预后相关,多元分析显示多灶肝转移,原发灶淋巴结转移、脉管瘤栓是其预后独立危险因素。结论:对出现孤立转移灶、原发灶无淋巴结转移且无脉管瘤栓的胃癌肝转移患者应手术切除以获得更好的预后。

Objective： To assess the prognosis of hepatic resection on gastric cancer with liver metastases. Methods： Twenty-five patients were included in the retrospective study, the clinicopathologic features and surgical outcome were examined as prognostic factors by univariate and multivariate analysis. Results： Twenty patients underwent synchronous hepatic resection and five metachronous hepatic resection. The 1-year, 3-year and 5-year survival rates after hepatic resection was 84%, 28% and 21%, respectively. The number and the distribution of liver metastases, the type of liver surgery, the histotype of primary cancer, the lymph node involved and vascular invasion were significant prognostic factors regarding overall survival. Multivariate analysis indicated that the lymph node involved, vascular invasion of cancer cells of the primary tumor and the multiple liver metastases were independent poor prognostic factors after hepatic resection. Conclusion： Hepatic resection on liver metastases should be attempted in patients with solitary liver metastases and without lymph node metastases, as well as with vascular invasion of primary gastric cancer, in order to obtain a better prognosis.