title: Systemic chemotherapy as a main strategy for liver metastases from gastric cancer.
abstract: BACKGROUND
  Liver metastasis is associated with poor prognosis in gastric cancer. Surgical resection and systemic chemotherapy have been reported to be effective in gastric cancer with liver metastasis (GCLM). However, the best strategy for GCLM has not been established.
  
  
  METHODS
  From May 2009 to July 2014, a consecutive series of GCLM patients in Zhongshan Hospital of Fudan University were studied. Treatment strategies were evaluated with regard to different extents of metastases.
  
  
  RESULTS
  A total of 163 patients were included. The overall survival was 10.1 months. Active treatment significantly prolongs the survival of GCLM patients. The overall survival time for patients with liver-limited metastases and extra-hepatic liver metastases was 11.6 mo and 8.7 mo, respectively (P = 0.012). The median survival time for liver-limited disease of H1, H2 and H3 was 14.2, 15.8, and 8.5 months, respectively (H3 vs H2, P = 0.001; H3 vs H1, P = 0.000; H1 vs H2, P = 0.900). Systemic chemotherapy was chosen as the main strategy for the 'extensive' patients with extra-hepatic metastases and H3 type liver-limited metastases. Patients' survival was benefited by multi-line chemotherapy. No differences were shown between systemic chemotherapy and curative resection or palliative resection in H1 and H2 liver-limited metastases (16.0 mo vs 12.0 mo, P = 0.711; 16.0 vs 18.8 months, P = 0.654).
  
  
  CONCLUSIONS
  Systemic chemotherapy was the main treatment for gastric cancer patients with liver metastases. Curative resection could be considered for highly selected patients.
authors.affiliation: Department of Oncology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Oncology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Oncology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Oncology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, China. shen.kuntang@zs-hospital.sh.cn.
authors.forename: K
authors.initials: K
authors.lastname: Shen
authors.affiliation: Department of Oncology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China. liu.tianshu@zs-hospital.sh.cn.
authors.forename: T
authors.initials: T
authors.lastname: Liu
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*
keywords: Chemotherapy; Hepatectomy; Liver metastasis; Stomach neoplasm