Hepatic metastases are the most common among gastric cancer metastases, accounting for 5% to 29%. Liver metastases from gastric cancer can be classified as solitary or multiple according to the number of liver metastases, and as limited, disseminated, or diffuse according to their distribution. For different types of liver metastases, the treatment modalities adopted by physicians may be different, and patient outcomes may vary.
What is the survival after liver metastasis?
At present, hepatectomy remains the only way for patients to achieve long-term survival.
However, because most liver metastases after radical gastric cancer are multiple or diffuse in the liver, few patients, about 10%, are able to undergo hepatic resection, and the 5-year survival rate for patients after surgery is less than 20%.
The number of liver metastases is the most important factor affecting patient outcome and is inversely related to postoperative survival, that is, the higher the number of metastases, the shorter the patient’s postoperative survival.
How are liver metastases managed without tumor invasion outside the liver?
Patients with postoperative liver metastases from gastric cancer whose extrahepatic organs, lymph nodes, and peritoneum have not been invaded are generally considered by physicians for the following treatment modalities:
- Hepatic resection for solitary liver metastases and multiple liver metastases confined to the hemi-liver. For this group of patients, hepatic resection is significantly more effective than other modalities.
- Palliative hepatic resection for disseminated liver metastases with no more than 3 metastases. Palliative hepatectomy has been increasingly challenged by hepatic artery infusion chemotherapy (HAIC) in terms of its role in patient outcomes.
- Hepatic artery infusion chemotherapy is indicated for disseminated and diffuse liver metastases with more than 4 metastases. This group of patients is not candidates for hepatic resection, and HAIC is often the treatment of choice.
How are liver metastases from extrahepatic tumor invasion managed?
Hepatic metastases after gastric cancer surgery.
Patients with postoperative liver metastases from gastric cancer who also have tumor invasion of extrahepatic organs, lymph nodes, or the peritoneum are usually inoperable. In these patients, systemic combination chemotherapy has some efficacy. Physicians may also consider biologic therapy, targeted therapy, and immune-supportive therapy, but the role of these treatments in improving patient outcomes remains to be further validated.
After finding liver metastases, doctors need to determine the status of liver metastases, including the number and distribution of metastases, and also assess whether the tumor has invaded other organs outside the liver, lymph nodes, or the peritoneum. After combining the above, the doctor will make individualized treatment recommendations. (Contributed by Wenbin Hou, Department of Gastrointestinal Oncology, The First Affiliated Hospital of China Medical University)