Système gastro-intestinal et digestif

Abstrait

A Study of Gastric Cancer Cases with Liver Metastasis

Keishiro Aoyagi, Kikuo Kouhuji, Junya Kizaki, Taro Isobe, Kousuke Hashimoto and Kazuo Shirouzu

The prognosis of gastric cancer patients with liver metastasis is very poor because many cases of gastric cancer with liver metastasis have multiple metastatic nodules in the liver and other non-curative factors, such as severe lymph node metastasis and/or peritoneal metastasis. The prognosis for gastric cancer patients with synchronous liver metastasis and the significance of hepatectomy including metachronous liver metastasis from gastric cancer in Kurume University Hospital are reported. Methods: A total of 77 gastric cancer patients with synchronous liver metastasis were admitted between 1995 and 2010 to Kurume University Hospital. There were 17 hepatectomy cases (synchronous metastasis 12 cases, metachronous metastasis 5 cases) from 1984 to 2010. Results: With respect to prognostic factors for gastric cancer cases with liver metastasis, significant differences were observed for peritoneal metastasis, histology, lymph node metastasis, gastrectomy, systemic chemotherapy, the number of stage IV factors, the number of metastatic nodules (within 3), and intra-hepatic arterial infusion (HAI). Multivariate analysis showed that histology, chemotherapy, and HAI were independent prognostic factors. The number of metastatic nodules in all 17 hepatectomy cases was within 3. Three of five cases with hepatectomy for metachronous metastasis were alive more than 5 years after hepatectomy. On the prognosis of hepatectomy cases, there were significant differences for synchronous or metachronous metastasis, lymph node metastasis, the number of stage IV factors, and the stromal volume of the primary site. Conclusions: Multimodal treatment including HAI is considered effective for gastric cancer cases with liver metastasis. If patients have no stage IV factors except for H factor, and the number of metastatic nodules is within 3, hepatectomy is recommended, especially for patients with metachronous liver metastasis, medullary stromal volume type, and low-grade lymph node metastasis.