胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料，对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例，5年生存率14．7％，明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示，浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355，P=0．012）和肝转移数目（RR：7．664，P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。

Prognostic analysis of patients with synchronous liver metastasis from gastric cancer following simultaneous gastric and liver resection

Objective To investigate the surgical results of hepatic resection for solitary metastasis form gastric cancer. Methods Clinical data of 53 patients who underwent simultaneous curative gastric and liver resection in our hospital from January 1998 to December 2012 were analyzed retrospectively. Univariate and multivariate analyses were performed to examine independent factors for survival. Results In 53 patients, the accumulated 5-year survival rate after hepatic resection was 11.3%, 14.7% for solitary metastasis and 0 for multiple metastases. The statistically significant prognostic factors affecting 5-year survival rates were found to be serosal invasion （P=0.000）, lymph node metastasis （P=0.000）, the degree of radical resection （P=0.044）, number of hepatic metastases （P= 0.000）, liver metastasis size （P=0.031）. Multivariate Cox regression analysis showed that the serosal invasion （RR：3.355, P =0.012） and number of hepatic metastasis （RR：7.664, P =0.000） were independent prognostic factors in patients with liver metastasis from gastric cancer. Conclusion The prognosis of solitary metastasis from gastric cancer without serosal invasion can be improved through active radical resection based on suitable indications.