Liver metastases from gastric carcinoma: A Case report and review of the literature
Liver metastases from gastric carcinoma: A Case report and review of the literature
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DOI：
10.1016/j.currproblcancer.2017.03.003
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发表时间：
2017-05-01
影响因子：
2.6
通讯作者：
Polkowski, Wojciech P.
中科院分区：
文献类型：
--
作者：
Polkowska-Pruszynska, Beata;Rawicz-Pruszyniski, Karol;Polkowski, Wojciech P.
胃癌（GC）是世界范围内第五大常见恶性肿瘤，也是第三大癌症死亡原因，手术仍然是唯一的治愈性治疗选择。胃癌肝转移（LMGC）患者的预后较差，转移性胃癌的最佳治疗方法仍存在争议。2002年，一位53岁的男性病人，因胃癌合并肝脏第八段少转移病灶而接受全胃切除联合直肠癌切除术。病理诊断为IV期胃腺癌（pT 3 N2 M1），接受了辅助化疗（顺铂、表阿霉素、亚叶酸和5-氟尿嘧啶）。2012年，腹部超声和经皮肝活检显示右肝叶转移复发。姑息化疗（表阿霉素、奥沙利铂和卡培他滨）后观察到疾病进展。尽管如此，仍然进行了扩大的右半肝切除术，切除了第1、4A、5、6、7和8段。病理学检查证实了大的KRAS和HER 2阴性LMGC。患者在重复肝切除术后47个月和原发性GC和同步肝转移瘤切除后13年仍存活且无疾病。根据对27篇文献的综述，胃、肝切除术后5年总生存率可达60%，中位生存期可达74个月。虽然结合积极的手术方法与全身治疗LMGC是有争议的，它可能会带来有利的结果。根据原发性肿瘤和肝转移的RO手术切除的可评估预测因素仔细选择患者可以治愈，如我们的病例介绍所示，观察到10年无复发生存率，随后由于肝转移成功重复肝切除术。(C)2017爱思唯尔公司All rights reserved.
Gastric carcinoma (GC) is the fifth most common malignancy worldwide but the third leading cause of cancer death, and surgery remains the only curative treatment option. Prognosis of patients with liver metastases from gastric carcinoma (LMGC) is poor, and the optimal treatment of metastatic gastric cancer remains a matter of debate. In 2002, a 53-year-old male patient with GC and synchronous oligometastatic lesion in liver VIII segment underwent a total gastrectomy combined with metastasectomy. The pathologic diagnosis was stage IV gastric adenocarcinoma (pT3N2M1), which was treated with adjuvant chemotherapy (cisplatin, epirubicin, leucovorin, and 5-fluorouracil). In 2012, abdominal ultrasound and percutaneous liver biopsy revealed recurrence of the metastasis in the right liver lobe. Progression of the disease was observed after palliative chemotherapy (epirubicin, oxaliplatin, and capecitabine). Nevertheless, an extended right hemihepatectomy, with excision of segments 1, 4A, 5, 6, 7, and 8, was still performed. Pathologic examination confirmed large KRAS- and HER2-negative LMGC. The patient is alive and free of disease 47 months after the repeated hepatectomy and 13 years after removal of the primary GC and synchronous liver metastasis. Based on review of 27 articles, 5-year overall survival rate following gastrectomy and liver metastasectomy may reach 60%, with median survival time up to 74 months. Although the combination of aggressive surgical approach with systemic therapy for LMGC is controversial, it may allow favorable outcome. Careful selection of patients based on evaluable predictive factors for RO surgical resection of both primary tumor and liver metastases can lead to cure, as shown in our case presentation, where a 10-year relapse free survival was observed, followed by successful repeated hepatectomy due to liver metastases. (C) 2017 Elsevier Inc. All rights reserved.