title: Metachronous hepatic metastases from gastric carcinoma: a multicentric survey.
abstract: BACKGROUND
  The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease.
  
  
  OBJECTIVE
  To survey the clinical approach to the subset of patients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance.
  
  
  METHODS
  Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated.
  
  
  RESULTS
  Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001).
  
  
  CONCLUSIONS
  Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible.
authors.affiliation: Surgical Clinic, University of Brescia, Italy. guido.tiberio@libero.it
authors.forename: G A M
authors.initials: GA
authors.lastname: Tiberio
authors.forename: A
authors.initials: A
authors.lastname: Coniglio
authors.forename: A
authors.initials: A
authors.lastname: Marchet
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.forename: S
authors.initials: S
authors.lastname: Giacopuzzi
authors.forename: L
authors.initials: L
authors.lastname: Baiocchi
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.forename: G
authors.initials: G
authors.lastname: de Manzoni
authors.forename: D
authors.initials: D
authors.lastname: Nitti
authors.forename: S M
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate