Abstract
BackgroundThe optimal treatments for gastric cancer with liver metastases (GCLM) remain controversial. This study aimed to evaluate the efficacy of hepatectomy, RFA and TACE as local treatments for GCLM.MethodsFrom 2001 to 2015, 119 consecutive patients who received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases were enrolled in this retrospective cohort study. Patients were divided into Group A (46, hepatectomy) and Group B (73, either or both RFA and TACE). Propensity score matching analysis was employed.ResultsThe propensity model revealed that hepatectomy was associated with significantly longer OS compared with either or both RFA and TACE (P=0.021). The 1-, 3- and 5-year OS rates were 80.5%, 41.5% and 24.4%, respectively in Group A; and 85.4%, 21.9% and 12.2%, respectively in Group B. Subgroup analyses indicated that hepatectomy was associated with significantly longer long-term survival compared with TACE (P=0.033) and RFA (P=0.010). TACE had a similar efficacy as RFA (P=0.518), but with significantly lower costs (P=0.014) in for patients with metachronous GCLM.ConclusionHepatectomy is the optimal local treatment for GCLM when surgical R0 resection is intended. TACE attained a similar prognosis as RFA with relatively high cost-effectiveness, particularly for patients with metachronous GCLM.
Highlights
Gastric cancer is the fourth most common tumor and the second most common cause of cancer-related death worldwide; the highest incidence is in Eastern Asia, where approximately 1,000,000 people per year are affected [1, 2]
The propensity model revealed that hepatectomy was associated with significantly longer overall survival (OS) compared with either or both Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) (P=0.021)
The results indicate that financial costs were similar for patients with synchronous gastric cancer with liver metastases (GCLM) (P=0.164)
Summary
Gastric cancer is the fourth most common tumor and the second most common cause of cancer-related death worldwide; the highest incidence is in Eastern Asia, where approximately 1,000,000 people per year are affected [1, 2]. Hematogenous dissemination is one of the main methods by which gastric cancer metastasizes; the liver is the organ most frequently involved, with an incidence of 30%-50% [3]. At the time of diagnosis, approximately 35% of patients have distant metastases, while 4%-14%. Gastric cancer liver metastases (GCLM) are associated with shorter survival [5, 6]. Surgical techniques and perioperative management have improved, and many patients with GCLM benefit from surgery [7,8,9]. The Japanese working group reached the conclusion that hepatectomy should be considered for carefully selected patients with GCLM[10]. The optimal treatments for gastric cancer with liver metastases (GCLM) remain controversial. This study aimed to evaluate the efficacy of hepatectomy, RFA and TACE as local treatments for GCLM
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