Original scientific article
Risk factors for liver metastases after curative surgical procedures for gastric cancer: a prospective study of 208 patients treated with surgical resection

https://doi.org/10.1016/j.jamcollsurg.2003.08.013Get rights and content

Abstract

Background

The aim of this study was to evaluate the risk of liver metastases after radical surgical treatment for gastric cancer, the potential risk factors involved, and the sensitivity of serum tumor markers during followup.

Study design

A total of 208 patients who had undergone curative resection for primary gastric cancer and a prospective followup protocol were studied. The association between clinicopathologic variables and hepatic recurrence was investigated using standard univariate methods and multivariate Cox regression analysis.

Results

Mean followup time (± SD) for the entire patient population was 51 ± 38 months (median 52 months) and was 88 ± 24 months (median 81 months) for disease-free patients. Recurrence of gastric cancer was documented in 109 of 208 patients (52.4%). Liver metastases were found in 28 of 208 patients (13.5%); in most of these patients (82.1%) diagnosis was made within 2 years after surgical treatment. The estimated cumulative risk of liver metastases after 5 years was 16.4%. Cox regression analysis identified lymph node involvement (adjusted relative risk [RR] = 6.28, 95% confidence interval [CI] = 2.11 to 18.70, p = 0.001), preoperative positivity for CEA, CA 19-9, or CA 72-4 (RR = 5.18, 95% CI = 1.75 to 15.37, p = 0.003), and intestinal histotype (RR = 3.08, 95% CI = 1.06 to 8.96, p = 0.039) as independent predictors of hepatic recurrence. In 27 of 28 cases hepatic recurrence was associated with an increase in CEA, CA 19-9, or CA 72-4 serum levels above the cutoff, either before or at the time of the clinical diagnosis (sensitivity 96.4%).

Conclusions

Preoperative positivity for serum tumor markers, lymph node involvement, and intestinal histotype are risk factors for liver metastases after radical surgical treatment for gastric cancer. Postoperative measurement of serum tumor markers may be useful for an early diagnosis of hepatic recurrence during followup.

Section snippets

Patients

For this study we considered 381 patients who had undergone resective surgical treatment for primary gastric cancer at our Institute between January 1988 and December 1997. From this series only patients who met the following criteria were selected: 1) those who underwent potentially curative surgical treatment, defined according to the Union Internationale Contra le Cancer (UICC) criteria;7 2) those who showed absence of second tumors; 3) those who gave their informed consent for the followup

Sites of recurrence

Recurrence of gastric cancer arose during the followup in 109 of 208 cases (52.4%). The 5-year disease-free survival of the entire patient population was 48.6% (Fig. 1). In 69 cases (33.2%) we observed locoregional recurrences; in 31 cases (14.9%) peritoneal carcinomatosis; and in 36 cases (17.3%) hematogenous dissemination. Multiple sites of recurrence were found in 22 of 109 recurrent cases.

Hepatic recurrence

Of the 36 patients with hematogenous metastases the liver was involved in 28 patients, with an

Discussion

Recurrence of gastric cancer is a frequent finding even after a potentially curative surgical procedure and takes place through three main ways of spreading: locoregional recurrence, peritoneal dissemination, and hematogenous metastases. Several autopsy and clinical studies are reported in the literature. Some of these studies showed that different clinical and pathologic variables are related to the various patterns of dissemination2, 3, 5, 6, 11, 12; but most of the clinical studies were

Acknowledgements

We thank Marie Basso for assistance with revision of the manuscript.

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    No competing interests declared.

    Supported by grant PAR 2000 from the University of Siena, Italy.

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