40例胃癌肝转移的手术治疗及预后

Analysis of post-resection prognosis of 40 patients with liver metastases from gastric cancer

目的分析胃癌肝转移患者的手术治疗效果及影响预后的冈素,以探讨其手术指征。方法回顾性分析2010年1月1日至2012年1月1日于我院胃肠外科行原发灶+肝转移灶切除的40例胃癌合并肝转移患者的临床资料,分析其手术效果并用Log—rank检验及Cox风险比例模型分别对胃癌肝转移患者的主要临床病理因素与预后的关系进行单因素和多凶素分析。结果 40例患者均顺利完成手术,其中行R0切除30例,R1切除10例,无R2切除者。术后并发症发生率为15.0%(6/40),无术后大出血及死亡病例。1年、2年及3年总生存率分别为37.5%(15/40)、10.0%(4/40)、0,中位生存期为10.5个月。单因素分析显示原发灶病理类型、原发胃癌侵犯浆膜、胃周淋巴结转移、血管癌栓、神经侵犯、转移灶分布、转移灶直径、肝转移类型、肝切除方式和手术根治程度与预后相关。多因素分析显示原发胃癌侵犯浆膜、血管癌栓、神经侵犯、转移灶直径和手术根治程度为预后的独立影响因素。结论原发胃癌未侵犯浆膜、无血管癌栓、无神经侵犯、肝转移灶直径<5 cm和R0切除者可能是胃癌肝转移行原发灶+肝转移灶切除术的受益人群,亦可能是较佳的手术适应证。

Objective To identify appropriate indications and efficacy of surgical treatment for patients with liver metastases from gastric cancer. Methods Medical records were retrospectively reviewed for 40 patients with liver metastases from gastric cancer who underwent gastrectomy with metastasectomy at our hospital between January 2010 and January 2012. Possible associations between clinicopathological factors and prognosis were analyzed using the log-rank test and Cox proportional hazards model. Results A total of 30 patients underwent R0 resection and 10 patients, R1 resection. No cases of death or severe complications such as massive hemorrhage were observed. Survival rates were 37.5% at 1 year, 10% at 2 years,and 0 at 3 years. Median survival time was 10.5 months. Single-factor analysis identified the following predictors of poor prognosis： primary gastric serous violations,primary pathology type,perigastric lymph note metastasis, vascular tumor emboli,perineural invasion, diameter of metastasis, distribution of metastases, type of liver metastases, liver resection and radical extent. Muhifactorial analysis identified the following predictors of poor prognosis：primary gastric serous violations, vascular tumor emboli, perineural invasion, diameter of metastasis and radical extent. Conclusion Indications for surgery in this type of patient may be the absence of primary serous violations, vascular tumor thrombi, and nerve invasion, the presence of liver metastases with a diameter 〈5 cm, and R0 resection.