Evaluation of hepatectomy and palliative local treatments for gastric cancer patients with liver metastases: a propensity score matching analysis
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Jiyang Li1,*, Kecheng Zhang1,*, Yunhe Gao1, Hongqing Xi1, Jianxin Cui1, Wenquan Liang1, Aizhen Cai1, Bo Wei1 and Lin Chen1
1Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
*These authors have contributed equally to this work
Lin Chen, email: [email protected]
Bo Wei, email: [email protected]
Keywords: stomach neoplasms, liver, hepatectomy, radiofrequency ablation, transarterial chemoembolization
Received: January 17, 2017 Accepted: May 23, 2017 Published: June 27, 2017
Background: The optimal treatments for gastric cancer with liver metastases (GCLM) remain controversial. This study aimed to evaluate the efficacy of hepatectomy, RFA and TACE as local treatments for GCLM.
Methods: From 2001 to 2015, 119 consecutive patients who received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases were enrolled in this retrospective cohort study. Patients were divided into Group A (46, hepatectomy) and Group B (73, either or both RFA and TACE). Propensity score matching analysis was employed.
Results: The propensity model revealed that hepatectomy was associated with significantly longer OS compared with either or both RFA and TACE (P=0.021). The 1-, 3- and 5-year OS rates were 80.5%, 41.5% and 24.4%, respectively in Group A; and 85.4%, 21.9% and 12.2%, respectively in Group B. Subgroup analyses indicated that hepatectomy was associated with significantly longer long-term survival compared with TACE (P=0.033) and RFA (P=0.010). TACE had a similar efficacy as RFA (P=0.518), but with significantly lower costs (P=0.014) in for patients with metachronous GCLM.
Conclusion: Hepatectomy is the optimal local treatment for GCLM when surgical R0 resection is intended. TACE attained a similar prognosis as RFA with relatively high cost-effectiveness, particularly for patients with metachronous GCLM.
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