Development of a prognostic index for gastric cancer with liver metastasis at the initial diagnosis: A single center retrospective study.

Abstract

Objective: Prognosis of gastric cancer patients with liver metastasis (GCLM) at initial diagnosis has been poor and the optimal treatment modality and prognostic factors have remained unclear. Therefore, we sought to investigate prognostic factors of GCLM at initial diagnosis. Methods: Medical records of 389 patients of GCLM at their initial diagnosis from 2005 to 2016 were examined. Univariate and multivariate analysis were conducted with log-rank tests and Cox proportional hazards model, respectively. Results: The median overall survival (OS) was 13.6 months (95% confidence interval (CI): 12.5-14.7 months). Four independent prognostic factors were identified by multivariate analysis: non-intestinal type of Lauren classification (Hazard Ratio (HR) = 1.921, 95% CI, 1.203-3.066), serum AFP level ≥ 20 ng/mL (HR = 1.691, 95% CI, 1.206-2.785), complicated with extrahepatic metastasis (HR = 1.700, 95% CI, 1.007-2.872), and good response to first-line chemotherapy (HR = 0.035, 95% CI, 0.219-0.560). A simple prognostic index was generated using three risk groups: good (0 or 1 risk factors, n = 61), moderate (2 risk factors, n = 53), and poor (3 or 4 risk factors, n = 33). The median overall survival (OS) for good, moderate, and poor risk groups was 10.5, 13.7 and 20.7 months, respectively. Survival differences among the groups were highly significant (P < 0.001). Conclusions: Four prognostic factors were identified for patients of GCLM at initial diagnosis. Using a simple prognostic index, the patients were divided into three different risk groups. This prognostic model could help clinicians in decision-making regarding treatment modality after first-line chemotherapy.