Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases

Kecheng Zhang, Lin Chen, Kecheng Zhang, Lin Chen

Abstract

Background: The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM.

Methods: We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus.

Results: A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful.

Conclusions: The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.

Keywords: Chinese consensus; gastric cancer; liver metastases.

Conflict of interest statement

Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
Chinese type for GCLM. GCLM, gastric cancer with liver metastases.
Figure 2.
Figure 2.
Flow chart of diagnosis and treatment. CEUS, contrast-enhanced ultrasonography; CT, computed tomography; GI, gastrointestinal; GCLM, gastric cancer with iver metastases; MDT, multidisciplinary treatment; MRI, magnetic resonance imaging; PET, positron emission tomography.

References

    1. D’Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 2004; 240: 808–816.
    1. Riihimaki M, Hemminki A, Sundquist K, et al. Metastatic spread in patients with gastric cancer. Oncotarget 2016; 7: 52307–52316.
    1. Cheon SH, Rha SY, Jeung HC, et al. Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol 2008; 19: 1146–1153.
    1. Wang W, Liang H, Zhang H, et al. Prognostic significance of radical surgical treatment for gastric cancer patients with synchronous liver metastases. Med Oncol 2014; 31: 258.
    1. Xiao Y, Zhang B, Wu Y. Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study. Ir J Med Sci 2019; 188: 415–424.
    1. Petrelli F, Coinu A, Cabiddu M, et al. Hepatic resection for gastric cancer liver metastases: a systematic review and meta-analysis. J Surg Oncol 2015; 111: 1021–1027.
    1. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: v38–v49.
    1. Montagnani F, Crivelli F, Aprile G, et al. Long-term survival after liver metastasectomy in gastric cancer: systematic review and meta-analysis of prognostic factors. Cancer Treat Rev 2018; 69: 11–20.
    1. Thelen A, Jonas S, Benckert C, et al. Liver resection for metastatic gastric cancer. Eur J Surg Oncol 2008; 34: 1328–1334.
    1. Tatsubayashi T, Tanizawa Y, Miki Y, et al. Treatment outcomes of hepatectomy for liver metastases of gastric cancer diagnosed using contrast-enhanced magnetic resonance imaging. Gastric Cancer 2017; 20: 387–393.
    1. Kim YK, Lee MW, Lee WJ, et al. Diagnostic accuracy and sensitivity of diffusion-weighted and of gadoxetic acid-enhanced 3-T MR imaging alone or in combination in the detection of small liver metastasis (</= 1.5 cm in diameter). Invest Radiol 2012; 47: 159–166.
    1. Jhaveri K, Cleary S, Audet P, et al. Consensus statements from a multidisciplinary expert panel on the utilization and application of a liver-specific MRI contrast agent (gadoxetic acid). AJR Am J Roentgenol 2015; 204: 498–509.
    1. Chinese Society of Abdominal Radiology. Chinese society of abdominal radiology expert consensus on liver magnetic resonance imaging with gadobenate dimeglumine. Chin J Hepatobiliarv Surg 2017; 9: 577–584.
    1. Chinese Society of Abdominal Radiology. Expert consensus on the clinical use of hepatobiliary specific MRI contrast agent, gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic-acid. Chin J Radio 2016; 9: 641–646.
    1. Arita J, Ono Y, Takahashi M, et al. Routine preoperative liver-specific magnetic resonance imaging does not exclude the necessity of contrast-enhanced intraoperative ultrasound in hepatic resection for colorectal liver metastasis. Ann Surg 2015; 262: 1086–1091.
    1. Kinkel K, Lu Y, Both M, et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology 2002; 224: 748–756.
    1. Wang C, Guo W, Zhou M, et al. The predictive and prognostic value of early metabolic response assessed by positron emission tomography in advanced gastric cancer treated with chemotherapy. Clin Cancer Res 2016; 22: 1603–1610.
    1. Ceniceros L, Chopitea A, Pardo F, et al. Intensified neoadjuvant multimodal approach in synchronous liver metastases from gastric cancer: a single institutional experience. Clin Transl Oncol 2018; 20: 658–665.
    1. Kuramoto M, Shimada S, Ikeshima S, et al. Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg 2009; 250: 242–246.
    1. Saito T, Nakanishi H, Mochizuki Y, et al. Preferential HER2 expression in liver metastases and EGFR expression in peritoneal metastases in patients with advanced gastric cancer. Gastric Cancer 2015; 18: 711–719.
    1. Kim ST, Cristescu R, Bass AJ, et al. Comprehensive molecular characterization of clinical responses to PD-1 inhibition in metastatic gastric cancer. Nat Med 2018; 24: 1449–1458.
    1. Smyth EC, Wotherspoon A, Peckitt C, et al. Mismatch repair deficiency, microsatellite instability, and survival: an exploratory analysis of the medical research council adjuvant gastric infusional chemotherapy (MAGIC) trial. JAMA Oncol 2017; 3: 1197–1203.
    1. Marrelli D, Roviello F, De Stefano A, et al. Risk factors for liver metastases after curative surgical procedures for gastric cancer: a prospective study of 208 patients treated with surgical resection. J Am Coll Surg 2004; 198: 51–58.
    1. Wang YK, Shen L, Jiao X, et al. Predictive and prognostic value of serum AFP level and its dynamic changes in advanced gastric cancer patients with elevated serum AFP. World J Gastroenterol 2018; 24: 266–273.
    1. Chen Y, Qu H, Jian M, et al. High level of serum AFP is an independent negative prognostic factor in gastric cancer. Int J Biol Markers 2015; 30: e387–e393.
    1. Shimada H, Noie T, Ohashi M, et al. Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the task force of the Japanese gastric cancer association. Gastric Cancer 2014; 17: 26–33.
    1. Wang Q, Yang Y, Zhang YP, et al. Prognostic value of carbohydrate tumor markers and inflammation-based markers in metastatic or recurrent gastric cancer. Med Oncol 2014; 31: 289.
    1. Kinoshita J, Fushida S, Harada S, et al. Type IV collagen levels are elevated in the serum of patients with peritoneal dissemination of gastric cancer. Oncol Lett 2010; 1: 989–994.
    1. Yamamoto M, Baba H, Toh Y, et al. Peritoneal lavage CEA/CA125 is a prognostic factor for gastric cancer patients. J Cancer Res Clin Oncol 2007; 133: 471–476.
    1. Lin JP, Lin JX, Cao LL, et al. Preoperative lymphocyte-to-monocyte ratio as a strong predictor of survival and recurrence for gastric cancer after radical-intent surgery. Oncotarget 2017; 8: 79234–79247.
    1. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines (version 5). Tokyo, Japan: Kimbara Publishing Corporation, 2018.
    1. Long D, Yu PC, Huang W, et al. Systematic review of partial hepatic resection to treat hepatic metastases in patients with gastric cancer. Medicine (Baltimore) 2016; 95: e5235.
    1. Markar SR, Mikhail S, Malietzis G, et al. Influence of surgical resection of hepatic metastases from gastric adenocarcinoma on long-term survival: systematic review and pooled analysis. Ann Surg 2016; 263: 1092–1101.
    1. Markar SR, Mackenzie H, Mikhail S, et al. Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England. Gastric Cancer 2017; 20: 379–386.
    1. Tiberio GA, Baiocchi GL, Morgagni P, et al. Gastric cancer and synchronous hepatic metastases: is it possible to recognize candidates to R0 resection? Ann Surg Oncol 2015; 22: 589–596.
    1. Kinoshita T, Kinoshita T, Saiura A, et al. Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases. Br J Surg 2015; 102: 102–107.
    1. Tsujimoto H, Ichikura T, Ono S, et al. Outcomes for patients following hepatic resection of metastatic tumors from gastric cancer. Hepatol Int 2010; 4: 406–413.
    1. Imamura H, Matsuyama Y, Shimada R, et al. A study of factors influencing prognosis after resection of hepatic metastases from colorectal and gastric carcinoma. Am J Gastroenterol 2001; 96: 3178–3184.
    1. Shinohara T, Maeda Y, Hamada T, et al. Survival benefit of surgical treatment for liver metastases from gastric cancer. J Gastrointest Surg 2015; 19: 1043–1051.
    1. Oki E, Tokunaga S, Emi Y, et al. Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302). Gastric Cancer 2016; 19: 968–976.
    1. Li J, Xi H, Cui J, et al. Minimally invasive surgery as a treatment option for gastric cancer with liver metastasis: a comparison with open surgery. Surg Endosc 2018; 32: 1422–1433.
    1. Li J, Zhang K, Gao Y, et al. Evaluation of hepatectomy and palliative local treatments for gastric cancer patients with liver metastases: a propensity score matching analysis. Oncotarget 2017; 8: 61861–61875.
    1. Liao YY, Peng NF, Long D, et al. Hepatectomy for liver metastases from gastric cancer: a systematic review. BMC Surg 2017; 17: 14.
    1. Song A, Zhang X, Yu F, et al. Surgical resection for hepatic metastasis from gastric cancer: a multi- institution study. Oncotarget 2017; 8: 71147–71153.
    1. Shirasu H, Tsushima T, Kawahira M, et al. Role of hepatectomy in gastric cancer with multiple liver-limited metastases. Gastric Cancer 2018; 21: 338–344.
    1. Schildberg CW, Croner R, Merkel S, et al. Outcome of operative therapy of hepatic metastatic stomach carcinoma: a retrospective analysis. World J Surg 2012; 36: 872–878.
    1. Kim KH, Lee KW, Baek SK, et al. Survival benefit of gastrectomy +/- metastasectomy in patients with metastatic gastric cancer receiving chemotherapy. Gastric Cancer 2011; 14: 130–138.
    1. Li Z, Fan B, Shan F, et al. Gastrectomy in comprehensive treatment of advanced gastric cancer with synchronous liver metastasis: a prospectively comparative study. World J Surg Oncol 2015; 13: 212.
    1. Chen L, Zhang K. Indications analysis for multiorgan resection in advanced gastric cancer. Chin J Practical Surg 2017; 37: 1095–1098.
    1. Kataoka K, Kinoshita T, Moehler M, et al. Current management of liver metastases from gastric cancer: what is common practice? New challenge of EORTC and JCOG. Gastric Cancer 2017; 20: 904–912.
    1. Al-Batran SE, Homann N, Pauligk C, et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 trial. JAMA Oncol 2017; 3: 1237–1244.
    1. Tiberio GA, Ministrini S, Gardini A, et al. Factors influencing survival after hepatectomy for metastases from gastric cancer. Eur J Surg Oncol 2016; 42: 1229–1235.
    1. Guner A, Son T, Cho I, et al. Liver-directed treatments for liver metastasis from gastric adenocarcinoma: comparison between liver resection and radiofrequency ablation. Gastric Cancer 2016; 19: 951–960.
    1. Komeda K, Hayashi M, Kubo S, et al. High survival in patients operated for small isolated liver metastases from gastric cancer: a multi-institutional study. World J Surg 2014; 38: 2692–2697.
    1. Qiu JL, Deng MG, Li W, et al. Hepatic resection for synchronous hepatic metastasis from gastric cancer. Eur J Surg Oncol 2013; 39: 694–700.
    1. Wang YN, Shen KT, Ling JQ, et al. Prognostic analysis of combined curative resection of the stomach and liver lesions in 30 gastric cancer patients with synchronous liver metastases. BMC Surg 2012; 12: 20.
    1. Takemura N, Saiura A, Koga R, et al. Long-term outcomes after surgical resection for gastric cancer liver metastasis: an analysis of 64 macroscopically complete resections. Langenbecks Arch Surg 2012; 397: 951–957.
    1. Miki Y, Fujitani K, Hirao M, et al. Significance of surgical treatment of liver metastases from gastric cancer. Anticancer Res 2012; 32: 665–670.
    1. Liu J, Li JH, Zhai RJ, et al. Predictive factors improving survival after gastric and hepatic surgical treatment in gastric cancer patients with synchronous liver metastases. Chin Med J (Engl) 2012; 125: 165–171.
    1. Garancini M, Uggeri F, Degrate L, et al. Surgical treatment of liver metastases of gastric cancer: is local treatment in a systemic disease worthwhile? HPB (Oxford) 2012; 14: 209–215.
    1. Makino H, Kunisaki C, Izumisawa Y, et al. Indication for hepatic resection in the treatment of liver metastasis from gastric cancer. Anticancer Res 2010; 30: 2367–2376.
    1. Ueda K, Iwahashi M, Nakamori M, et al. Analysis of the prognostic factors and evaluation of surgical treatment for synchronous liver metastases from gastric cancer. Langenbecks Arch Surg 2009; 394: 647–653.
    1. Sakamoto Y, Sano T, Shimada K, et al. Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol 2007; 95: 534–539.
    1. Koga R, Yamamoto J, Ohyama S, et al. Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol 2007; 37: 836–842.
    1. Sakamoto Y, Ohyama S, Yamamoto J, et al. Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients. Surgery 2003; 133: 507–511.
    1. Kumagai K, Tanaka T, Yamagata K, et al. Liver metastasis in gastric cancer with particular reference to lymphatic advancement. Gastric Cancer 2001; 4: 150–155.
    1. Yoshikawa T, Sasako M, Yamamoto S, et al. Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg 2009; 96: 1015–1022.
    1. Matsumoto T, Sasako M, Mizusawa J, et al. HER2 expression in locally advanced gastric cancer with extensive lymph node (bulky N2 or paraaortic) metastasis (JCOG1005-A trial). Gastric Cancer 2015; 18: 467–475.
    1. Wang FH, Shen L, Li J, et al. The Chinese society of clinical oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer. Cancer Commun (Lond) 2019; 39: 10.
    1. Chen L, Xi H, Shen W. Multidisciplinary therapy for gastric cancer with liver metastasis. Chin J Gastrointest Surg 2014; 17: 101–104.
    1. Su X, Xing J. Expert consensus on the diagnosis and treatment by the multidisciplinary treatment group for gastric cancer. Chin J Practical Surg 2017: 37–38.
    1. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687–697.
    1. Chen J, Tang Z, Dong X, et al. Radiofrequency ablation for liver metastasis from gastric cancer. Eur J Surg Oncol 2013; 39: 701–706.
    1. Dittmar Y, Altendorf-Hofmann A, Rauchfuss F, et al. Resection of liver metastases is beneficial in patients with gastric cancer: report on 15 cases and review of literature. Gastric Cancer 2012; 15: 131–136.
    1. Chen H, Gao S, Yang XZ, et al. Comparison of safety and efficacy of different models of target vessel regional chemotherapy for gastric cancer with liver metastases. Chemotherapy 2016; 61: 99–107.
    1. Chen H, Liu P, Xu HF, et al. Low-dose, short-interval target vessel regional chemotherapy through the hepatic artery combined with transarterial embolization in gastric cancer patients with liver metastases after failure of first-line or second-line chemotherapy: a preliminary analysis. Anticancer Drugs 2014; 25: 92–100.
    1. Vogl TJ, Gruber-Rouh T, Eichler K, et al. Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: local control and survival results. Eur J Radiol 2013; 82: 258–263.
    1. Fukami Y, Kaneoka Y, Maeda A, et al. Adjuvant hepatic artery infusion chemotherapy after hemihepatectomy for gastric cancer liver metastases. Int J Surg 2017; 46: 79–84.
    1. Wang YY, Zhang W, Qian S, et al. The effect of locoregional transarterial infusion chemotherapy on liver metastasis after gastric cancer resection. J Int Med Res 2012; 40: 1141–1148.
    1. Seki H, Ohi H, Ozaki T, et al. Hepatic arterial infusion chemotherapy using fluorouracil, epirubicin, and mitomycin C for patients with liver metastases from gastric cancer after treatment failure of systemic S-1 plus cisplatin. Acta Radiol 2016; 57: 781–788.
    1. Lee JW, Choi MH, Lee YJ, et al. Radiofrequency ablation for liver metastases in patients with gastric cancer as an alternative to hepatic resection. BMC Cancer 2017; 17: 185.
    1. Hwang JE, Kim SH, Jin J, et al. Combination of percutaneous radiofrequency ablation and systemic chemotherapy are effective treatment modalities for metachronous liver metastases from gastric cancer. Clin Exp Metastasis 2014; 31: 25–32.
    1. Hofer S, Oberholzer C, Beck S, et al. Ultrasound-guided radiofrequency ablation (RFA) for inoperable gastrointestinal liver metastases. Ultraschall Med 2008; 29: 388–392.
    1. Ryu T, Takami Y, Wada Y, et al. Oncological outcomes after hepatic resection and/or surgical microwave ablation for liver metastasis from gastric cancer. Asian J Surg 2019; 42: 100–105.
    1. Chang X, Wang Y, Yu HP, et al. CT-guided percutaneous cryoablation for palliative therapy of gastric cancer liver metastases. Cryobiology 2018; 82: 43–48.
    1. Fukumitsu N, Okumura T, Takizawa D, et al. Proton beam therapy for liver metastases from gastric cancer. J Radiat Res 2017; 58: 357–362.
    1. Sato KT, Lewandowski RJ, Mulcahy MF, et al. Unresectable chemorefractory liver metastases: radioembolization with 90Y microspheres–safety, efficacy, and survival. Radiology 2008; 247: 507–515.
    1. Zhang H, Chen J. Current status and future directions of cancer immunotherapy. J Cancer 2018; 9: 1773–1781.
    1. Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538–12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017; 390: 2461–2471.
    1. Shitara K, Ozguroglu M, Bang YJ, et al. Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesophageal junction cancer (KEYNOTE-061): a randomised, open-label, controlled, phase 3 trial. Lancet 2018; 392: 123–133.

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