胃癌肝转移综合治疗

肝转移是胃癌发展的终末阶段,是导致死亡的主要原因,并且是晚期胃癌的治疗难点之一。目前,多种方法被用来控制胃癌肝转移,包括手术切除、系统治疗、消融治疗、介入治疗和靶向治疗,但是具体方案尚无定论。多学科团队（MDT）综合治疗模式已经使更多的病人获得了生存期的延长及生活质量的提高,因此,掌握各种治疗方法的适应证尤为重要。     

胃癌肝转移的外科综合治疗

胃癌是常见的消化道恶性肿瘤,全球范围内死亡率占第2位,尤其在东北亚地区(中国、日本、韩国)高发[1-2]。由于胃癌细胞自身的生物学异质性,即便接受根治性胃癌切除术,晚期胃癌仍有较高的复发转移风险。其转移复发途径主要有:局部复发、淋巴结转移复发、腹膜种植和血行转移。根据癌细胞转移的解剖/机械假设学说[3],胃癌细胞血行转移到达的第一个靶器官应是肝脏,其次是肺[4-5]。肝脏是胃癌根治术后常见的转移部位,晚期     

胃癌肝转移的综合治疗策略

<正>胃癌(Gastric cancer,GC)是人类消化道肿瘤最常见的种类之一,在全球范围内发病率与癌症相关死亡率分别位列第五位和第四位^[1]。根据2022年我国国家癌症中心发布的数据,胃癌在我国的发病率与癌症相关死亡率均位列第三^[2]。由于早期缺乏特异性症状和有效分子标志物,胃癌通常发现较晚,预后较差。其中,原发病灶的局部和远处转移是胃癌患者生存率低的主要原因^[3]。从解剖学上讲,肝脏是晚期胃癌最常见的血行转移部位。据统计,4～14%的患者在诊断时有肝脏转移^[4-6]。     

胃癌肝转移诊断与综合治疗中国专家共识解读

正胃癌是我国最常见的恶性肿瘤之一,据中国胃肠外科联盟统计的数据显示局部进展期胃癌占全部确诊病例的70%。以手术为主的围手术期综合治疗是我国胃癌临床治疗的最重要的治疗模式。肝脏是胃癌血行转移最常见的部位。胃癌肝转移是Ⅳ期胃癌的典型表现,按照肿瘤学治疗原则应该以全身治疗为主。Kodera等[1]将胃癌转移分成淋巴结转移、肝转移和腹膜转移三种主要类型。肿瘤细胞进入门静脉后第一站到达肝脏,然后可能转移至肺和其他远处脏器,如骨骼、肾上腺和脑等。从解     

胃癌肝转移八例的外科治疗

我院 1988～ 1993年间行胃癌切除术 42 8例 ,其中同时发现肝转移者 2 1例 ,占 4 9%。我们对 8例肝转移者行根治性胃切除术同时切除肝转移灶 ,其余 13例仅行胃癌切除术 ,而对肝转移灶未作特殊处理。两组病例治疗效果报告如下。一、临床资料1 一般资料 :肝转移灶切除组 8例 ,其中男性 6例 ,女性2例 ,年龄 47～ 71岁 ,平均 5 6 8岁 ,肝转移均经病理学检查证实 ;肝转移灶未切除组 13例 ,其中男 11例 ,女 2例 ,年龄 42～74岁 ,平均 6 1岁 ,经手术探查证实肝转移。2 术中发现 :肝转移灶切除组 (8例 ) :其中胃原发癌Ｂｏｒ ｒｍａｎｎⅡ型 3例 ,…     

胃癌同时性肝转移的外科治疗

目的:探讨胃癌同时性肝转移外科治疗方法及疗效。方法:回顾性分析2004年3月—2016年4月21例胃癌同时性肝转移患者行胃癌D2根治术的临床资料,根据有无行肝脏R0切除分为R0切除组(11例)和非R0切除组(10例),对两组临床病理特征和生存情况进行比较。结果:R0切除组1,2,3年生存率分别为54.5%,27.3%和27.3%;非R0切除组分别为48.0%,0和0(P=0.044)。中位生存期分别为16.2月和5.9月(P=0.008)。对R0切除组生存资料进行单因素分析发现Bormann分型(P=0.004)、区域淋巴结受累(P=0.010)与患者预后有关;多因素分析无明显独立预后因素,可能与Bormann分型与淋巴结受累存在交互作用(P=0.031)有关。结论:基于胃癌D2切除联合肝脏R0切除的多学科治疗可以提高疗效。     

胃癌同时性肝转移手术治疗效果分析

目的 评价胃癌同时性肝转移外科效果.方法 回顾性分析2005～2017年间就诊于安徽医科大学第一附属医院行手术治疗的40例胃癌同时性肝转移患者,所有患者均行胃原发灶D2切除,根据肝脏转移灶是否行R0切除,分为A组肝脏转移灶切除(20例)与B组肝脏转移灶未切除(20例),比较两组临床资料及术后生存情况.结果 两组术后并发...     

胃癌肝转移的手术治疗

目的 探讨胃癌肝转移行肝切除术的适应证及疗效。方法 对1990年1月至1999年11月间施行肝切除的24例胃癌肝转移患的临床资料进行回顾性分析。结果 本组同时性肝转移19例，异时性转移5例。共施行肝段叶切除8例，肝部分切除16例；19例同时性肝转移患均在肝切除的同时加行根治性胃切除术。术后并发肝昏迷死亡l例。手术死亡率为4．2％。全组22例获得随访。术后1年、3年和5年生存率分别为45．5％、18．2％和9．1％。生存分析显示，肝切除术后的生存率不仅与胃癌原发灶的分化程度、有无浆膜面浸润和淋巴结转移有关，而且与肝转移灶的数目及其在肝脏内的分布范围有关。结论对于胃癌孤立性肝转移患，其原发病灶可根治切除的应积极采用手术治疗，部分患可获长期生存。     

胃癌肝转移诊断与综合治疗中国专家共识（2019版）

正肝脏是胃癌血行转移最常见的靶器官[1]。胃癌肝转移的总体发生率约9.9%～18.7%[2-3],其中同时性胃癌肝转移的比例约73.3%,异时性胃癌肝转移的比例约26.7%[4]。胃癌根治术后发生肝脏转移的中位间隔时间约14个月,中位生存时间约11个月,5年存活率20%[5]。经原发灶、转     

积极开展对胃癌肝转移的多学科团队综合治疗

胃癌肝转移（GCLM）是晚期胃癌患者死亡的主要原因。GCLM以多发性转移居多．且常伴有肝外病变．特别是腹膜转移,其中绝大多数的肝转移灶无法获得根治性切除。目前,治疗GCLM的方法主要包括根治性手术治疗、胃癌姑息性切除、转移灶消融治疗、介入治疗以及全身化疗等。根据GCLM治疗现状以及解放军总医院普通外科的临床实践,对于GCLM患者,应综合分析患者的全身状态、原发胃癌类型及肝转移程度等,以个体化治疗为原则,通过多学科团队合作,开展积极的综合治疗,选择合适的综合治疗方法。     

Resection of liver metastasis from alpha-fetoprotein-producing early gastric cancer: Report of a case

We herein present a case of resected synchronous solitary liver metastasis from alpha-fetoprotein (AFP)-producing early gastric cancer. A 61-year-old woman, who was diagnosed at a routine medical checkup as having early gastric cancer with a liver tumor, came to our hospital for surgery. Her serum AFP level was high at 910ng/ml. An examination was performed to determine whether the liver tumor was primary hepatocellular carcinoma or metastasis from early gastric cancer. She had no evidence of either a hepatitis B or C virus infection, and her liver function was normal. A biopsy specimen from the gastric cancer predominantly revealed moderately differentiated adenocarcinoma, but a focally trabecular pattern compatible with AFP-producing gastric cancer was also observed. Preoperatively, it was concluded that the liver tumor was metastasis from an AFP-producing early gastric cancer. We thus performed distal gastrectomy and a posterior segmentectomy of the liver. Her serum AFP level decreased to the normal range within 2 weeks after the operation. An immunohistological examination revealed that AFP-positive cells were present in both the gastric cancer and liver tumor. One year after the operation, there was no sign of recurrence.     

胃癌微血管密度与肝转移相关性研究

目的　探讨胃癌组织中微血管计数及其分布方式与肝转移的关系。方法　用LSAB免疫组化法测定胃癌标本 65例 ,在 2 0 0倍视野下计数 5个血管最多有肿瘤区域 ,观察血管在癌组织的分布方式。结果　微血管计数在 5～ 70的范围 ,其平均数±标准差为 ( 15 .2 2± 7.66)。微血管密度MVD与肿瘤浸润深度、组织学类型、生长方式等无关 ,但与有无肝、淋巴结转移有显著的相关性 (P <0 .0 5 )。肿瘤内型发生肝转移更多见。分化型癌多为肿瘤内型血管分布。结论　MVD是反映胃癌预后的一个重要参数 ,为肝转移的早期预测提供客观依据     

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P₀H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P₀H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.     

肝移植术后复发性肝细胞癌的多学科治疗

肝移植(liver transplantation,LT)是目前治疗原发性肝癌的最有效措施,尽管经过严格的选择标准,但术后常常发生复发,影响着患者的长期存活。据报道,肝移植术后复发(recurrence after liver transplantation)的发生率估计在6%～50%,并且在移植后的前两年中更常发生。本文就肝移植术后复发的多学科治疗策略进行综述。     

Early gastric cancer associated with synchronous liver metastasis and portal tumorous embolism: Report of a case

(Received for publication on July 25, 1996; accepted on July 8, 1997)     

Bone metastasis of gastric cancer

Twenty-three patients with bone metastasis from gastric cancer which was resected during the ten years from 1970 through 1979 were investigated. The incidence was 1.2 per cent (23/1,945), and was higher in the younger patients. The main symptom was local bone pain. Change on the X-ray appeared a few months after complaints of pain. Consequently, the confirmation was delayed in most cases. All of the laboratory findings were not specific to bone metastasis. Referring to findings at the primary surgery for gastric cancer, this form of metastasis occurred in cases of a high involvement of regional lymph nodes and of a scirrhous type. The results of histological examination showed a high degree of lymphatic permeation in the submucosal layer. Poorly differentiated adenocarcinoma was readily identified. The lumbar and thoracic vertebra were the areas of frequent metastases. The metastasis occurred within two years after the gastric surgery, in most cases. Chemotherapy was ineffective and radiotherapy was effective for palliation of the bone pain. Prognosis was very poor and all but one patient died within a few months after confirmation of the metastasis. This work was presented at the 20th Congress of the Japan Society for Cancer Therapy, Tokyo, September, 1982.     

胃癌肝转移新辅助治疗与手术选择

目前,外科手术治疗仍然是胃癌肝转移（GCLM）病人的合理治疗方式之一,手术治疗后部分病人可获得长期存活。新辅助治疗包括全身化疗和经血管介入技术可以为GCLM手术治疗创造条件,从而扩大根治性手术治疗的应用范围。GCLM手术的新辅助治疗指征和疗效仍存在争议,需要经过多中心的前瞻性随机对照研究来证实。     

肝动脉化疗栓塞治疗胃癌肝转移的临床疗效

目的评价肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）治疗胃癌肝转移的临床疗效、毒副反应及生活质量的改善情况。方法收集31例同时性胃癌伴肝转移患者的临床资料,行TACE治疗。结果全组患者完全缓解（CR）4例,占12.9%;部分缓解（PR）17例,占54.8%;病变稳定（SD）6例,占19.4%;病变进展（PD）4例,占12.9%,总有效率（CR＋PR）为67.7%。结论针对胃癌肝转移患者,TACE治疗是有效的。     

Clinicopathological study of brain metastasis in gastric cancer patients

P = 0.0177). Aggressive multidisciplinary treatment, including a resection, for brain metastasis should improve the quality of life and prolong life expectancy. (Received for publication on Aug. 5, 1999; accepted on Jan. 7, 2000)