Management of liver metastases from gastric carcinoma: Where is the evidence?
Background: Liver metastases of gastric carcinoma are often the synonym of advanced neoplastic disease which has long justified the indication of palliative chemotherapy. However, inspired by the good results of the management of liver metastases of colorectal cancers,several surgeons have focused on the treatment of liver metastases of gastric carcinoma. The different therapeutic modalities used are surgery, radiofrequency ablation, hepatic arterial infusion and palliative gastrectomy. Aims: To provide evidence based answer to the following questions regarding liver metastases from gastric carcinoma: 1. What is the indication of surgery? 2. Does radiofrequency ablation useful? 3. What is the contribution of the hepatic arterial infusion? 4. Is there any benefit to palliative gastrectomy? Methods: A literature search on PubMed database over the period from January 1990 to December 2011 was conducted using as key words "gastric cancer" and "liver metastases". Results: Surgery of a single liver metastasis smaller than 5 cm and not associated with another metastatic site offers better results in terms of 5-year survival rate than palliative chemotherapy. Intra hepatic arterial chemotherapy offers an alternative to surgery in inoperable patients and can be proposed as neo adjuvant treatment to surgery. The interest of radiofrequency ablation and palliative gastrectomy remains unproven. Conclusion: Surgery is a good indication for single liver metastasis of gastric carcinoma less than 5 cm and not associated with another extra hepatic metastasis.
Available from: PubMed Central
- "The five-year survival rate for gastric cancer patients with liver metastases remains less than 5%
, and there are still no effective means of prevention and treatment
. The present study confirmed that c-Met was closely related to liver metastasis of gastric cancer which is consistent with the literature
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ABSTRACT: Recent studies have suggested that the metastasis-associated colon cancer1 (MACC1) gene can promote tumor proliferation, invasion and metastasis through an upregulation of c-Met expression. However, its role in gastric cancer is controversial. Our study investigated expression of MACC1 and c-Met in gastric cancer, as well as correlated this with clinicopathological parameters.
Expressions of MACC1 and c-Met protein in a sample of 98 gastric carcinoma and adjacent nontumorous tissues were detected by immunohistochemistry. Their relationships and correlations with clinicopathological features were analyzed.
The positive rates of MACC1 and c-Met protein in primary tumors were 61.22% and 59.18%, respectively. A significant correlation was found between expression of MACC1 and c-Met (P<0.05). Expression of the MACC1 protein in gastric cancer tissue was correlated with lymph node metastasis(chi2 = 10.555,P = 0.001), peritoneal metastasis (chi2 = 5.694, P = 0.017), and hepatic metastasis (chi2 = 4.540,P = 0.033), but not with age, gender, tumor size, location, clinical stage or the distant metastases (P>0.05).
The positive rate of MACC1 protein expression was related to the protein expression of c-Met. Both had a correlation with the presence of peritoneal metastasis, lymph node metastasis and hepatic metastasis, all of which contribute to a poor prognosis for gastric cancer patients.
Available from: Daniel V Kostov
- "GCLM were diagnosed through endoscopy and biopsy, echography, computer axial tomography (CAT) and intraoperative echography. The following criteria were actually accepted for GCLM resection: 1) good control and complete resection of the primary tumour and lymph nodes involvement in synchronous disease; 2) no signs at preoperative workup of disseminated diseases, hilar lymph nodes metastases, peritoneal dissemination, or extrahepatic metastases; 3) complete LM resection (no residual tumour at macroscopical examination) . According to these criteria, twenty-eight out of a total of 140 patients having undergone initial hepatectomy were selected for this study. "
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ABSTRACT: Background: Hepatectomy for gastric metastases remains controversial. We aimed at assessing the surgical results, clinicopathological features of gastric cancer liver metastases (GCLM) and prognostic factors. Methods: The outcome of 28 consecutive patients with synchronous (n = 24) or metachronous (n = 4) GCLM was retrospectively analyzed. Curatively, initial hepatectomies such as segmentectomy and hemihepatectomy or non-anatomical limited liver resec-tion less extensive than segmentectomy followed complete primary gastric cancer (GC) resections. Results: Median survival time was 16 months (range, 5 -66 months). The actuarial overall 12-, 36-, and 60-month survival rates after hepatectomy were 67.8% (n = 19), 39.2% (n = 11), and 28.5% (n = 8), respectively. In multivariate analysis, absent GC serosal invasion-hazard ratio (HR) 1; 95% confidence interval (CI) 1.2 -9.9; P = 0.020; solitary LM-HR 1; 95% CI 1.6 -16.0; P = 0.005, and curative liver resection with negative resection margin (R0)-HR 1, 95% CI 2.2 -18.0; P = 0.001 were independent prognostic factors. Conclusions: Surgery of GCLM is a good indication in well-selected patients with an absent serosal invasion of primary tumour, single GCLM and attainment of R0 liver resection. For most GCLM patients, however, there are no other therapeutic modalities. Thus systemic chemotherapy remains the best hope for a longer patient's survival and an improved individual quality of life.
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ABSTRACT: The authors focused on the current surgical treatment of resectable gastric cancer, and significance of peri- and post-operative chemo or chemoradiation. Gastric cancer is the 4(th) most commonly diagnosed cancer and the second leading cause of cancer death worldwide. Surgery remains the only curative therapy, while perioperative and adjuvant chemotherapy, as well as chemoradiation, can improve outcome of resectable gastric cancer with extended lymph node dissection. More than half of radically resected gastric cancer patients relapse locally or with distant metastases, or receive the diagnosis of gastric cancer when tumor is disseminated; therefore, median survival rarely exceeds 12 mo, and 5-years survival is less than 10%. Cisplatin and fluoropyrimidine-based chemotherapy, with addition of trastuzumab in human epidermal growth factor receptor 2 positive patients, is the widely used treatment in stage IV patients fit for chemotherapy. Recent evidence supports the use of second-line chemotherapy after progression in patients with good performance status.
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