Objective To assess the surgical results and implications of clinicopathologic features on the prognosis of patients with hepatic metastases from gastric adenocarcinoma.Methods One hundred and six out of 1982 patients with primary gastric cancer were diagnosed as hepatic metastasis, including 91 cases of synchronous metastasis and 15 cases of metachronous metastasis.Clinical data of 23 patients with liver metastases from gastric cancer who underwent gastrectomy and hepatectomy for metastasis were retrospectively reviewed.Results The overall 1, 3 and 5-year survival rates of 23 patients were 65.2 ％, 35.6 ％ and 16.8％, respectively; and three patients survived for more than 5 years after surgery.In univariate analysis,absence of serosal invasion, solitary and metachronous liver metastasis were significant determinants for a favorable prognosis after hepatic resection.Multivariate analysis revealed that metachronous and solitary liver metastasis were favorable independent prognostic factors (P =0.006 and P =0.002, respectively).Retrospectively, 8 of the 83 patients with liver metastases who did not undergo hepatic resection were possible candidates for hepatic resection at diagnosis.The actuarial 1-year and 3-year survival rates for these eight patients were 37.5％ and 0％.The survival rate in the unresected group was significantly (P ＜0.01) lower than that in the resected group.Conclusion Surgery for liver metastases from gastric adenocarcinoma is beneficial if complete resection is feasible after careful preoperative staging.Metachronous and solitary liver metastases from gastric cancer confer a better prognosis.%目的 评价胃癌肝转移灶行肝切除的疗效并分析临床病理因素对其预后的影响.方法 1982例胃癌患者中106例诊断为肝转移,其中同时性肝转移91例(4.6%),异时性转移15例(0.7%),23例行胃癌肝转移灶切除术,对该23例患者的临床和病理资料进行分析.结果 23例胃癌肝转移灶切除患者术后1、3、5年生存率分别为65.2%、35.6%、16.8%,3例生存超过5年;单因素分析显示单肝转移灶、异时性肝转移和胃浆膜层未受累是胃癌肝转移灶切除患者有利的预后因素,但多因素分析显示前两者是其有利的预后因素.83例胃癌肝转移未行手术切除者中,8例有肝切除可能,该8例的1、3年生存率分别为37.5%和0%,未行肝切除者的生存率明显低于肝切除者(P＜0.01).结论 对能进行根治性切除的胃癌肝转移患者应采取积极的手术治疗,单肝转移灶和异时性肝转移患者有较好的预后.
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