胃癌同时性肝转移肝切除的疗效及预后分析

Analysis of efficacy of hepatectomy and prognostic risk factors in patients with gastric cancer with synchronous liver metastasis

背景与目的:胃癌同时性肝转移(gastric cancer with synchronous liver metastases,GCLM)患者是否接受肝切除仍存在争议。本研究通过分析GCLM患者的临床病理学特征及治疗方式,探究其与患者预后的关系,希望为该病的临床治疗及预后评价提供参考依据。方法:回顾性分析2006年3月—2018年8月复旦大学附属肿瘤医院收治的经术后病理学检查诊断为胃腺癌,影像学检查提示伴有肝转移的患者资料,包括性别、年龄、原发灶大小、部位、浸润深度、淋巴结转移、分化程度、肝转移灶大小、分布、数目、治疗方法及甲胎蛋白(alpha fetoprotein,AFP)、癌胚抗原(carcinoembryonic antigen,CEA)等肿瘤标志物水平,并进行随访。采用Kaplan-Meier生存曲线分析患者的总生存期(overallsurvival,OS),用log-rank检验进行单因素分析,COX回归模型进行多因素分析,探究影响GCLM患者生存的独立预后因素,通过亚组分析筛选最佳的肝切除对象。结果:79例纳入本研究的GCLM患者的中位发病年龄为63岁,男女比例为5.58∶1.00。中位OS为11个月,1、3和5年OS率分别为46.0%、23.3%和6.9%。单因素分析结果显示,影响OS的因素包括胃原发灶大小、分化程度、肝转移灶的分布、确诊时血清AFP水平及肝切除。多因素分析结果显示,影响OS的独立危险因素为双叶肝转移(HR=37.253,P=0.008),保护因素为肝切除(HR=0.149,P=0.044)。进一步亚组分析显示,对转移灶最大直径≤3cm、单发肝转移灶、单叶转移、确诊时血清AFP及CEA水平正常者,肝切除有可能改善其OS。结论:回顾性研究表明肝切除有可能改善部分GCLM患者的预后。

Background and purpose:Whether patients with gastric cancer with synchronous liver metastases(GCLM)receive hepatectomy remains controversial.In this study,we analyzed the clinicopathological characteristics and treatment modalities of patients with GCLM to investigate their relationship with prognosis,hoping to provide a reference basis for the clinical treatment and prognostic evaluation of this disease.Methods:The patients admitted to the Fudan University Shanghai Cancer Center from March 2006 to August 2018 who were diagnosed with gastric adenocarcinoma by postoperative pathology and liver metastases by imaging examination were retrospectively analyzed,including gender,age,primary tumor size,location,depth of invasion,lymph node metastasis,differentiated degree,metastatic tumor size,distribution,number,the treatment,serum alpha fetoprotein(AFP)and carcinoembryonic antigen(CEA)level at diagnosis,and combined with follow-up investigation.The Kaplan-Meier method was used to analyze the overall survival(OS)of the patients,log-rank test was applied for univariate analysis,and the COX regression model was used for multifactorial analysis to explore the independent prognostic factors affecting the OS of patients with GCLM.The best target for hepatectomy was screened by further subgroup analysis.Results:The median age of onset in 79 patients with GCLM admitted to this study was 63 years,and the male to female ratio was 5.58 vs 1.00.The median OS was 11 months,the 1-year,3-year and 5-year OS rates were 46.0%,23.3%,and 16.9%,respectively.The results of the univariate analysis showed that the factors affecting OS include primary tumor size,differentiated degree,hepatic tumor distribution,serum AFP level at diagnosis and hepatectomy.The results of multivariate analysis showed that the independent risk factor affecting OS was bilateral liver metastasis(HR=37.253,P=0.008),and the protective factor was hepatectomy(HR=0.149,P=0.044).Further subgroup analysis showed that hepatectomy improved OS in the subgroup with metastatic tumor size≤3 cm,single liver metastasis,unilateral metastasis and normal serum AFP and CEA levels at diagnosis.Conclusion:Retrospective study suggests that hepatectomy may improve the prognosis of some patients with GCLM.