Abstract: Objective:To evaluate systematically the longterm efficacy and prognostic factors of surgical treatment for gastric carcinoma with liver metastases(GCLM).
Methods: Database including Chinese Journal Full Text Database，Wan Fang Database, VIP database, Chinese Database of Literature on Biomedicine, Pubmed, EMBASE, Cochrane Library，Medline, Springerlink and Wiley Online Library were searched with “胃癌, 胃肿瘤, 肝转移, 手术治疗, 外科手术, 肝切除术, 生存率, 预后因素, gastric cancer, gastric carcinoma, hepatic, resection, hepatic resection, hepatectomy, liver metastases, hepatic metastases, surgery, surgical, survival, prognostic factors”. The time for retrieving was from January 1995 to August 2015. Literatures on longterm efficacy and prognostic factors of radical resection of gastric carcinoma combined with hepatectomy for GCLM were retrieved, and data were analyzed and evaluated by 2 independent researchers. The count data were presented by the relative risk (〖ＷＴＢＸ〗RR〖ＷＴＢＺ〗) and 95% confidence interval 〖ＷＴＢＸ〗(95%CI)〖ＷＴＢＺ〗. The group rate was merged by the formula RR/(1+RR), corresponding 95%CI upper limit values were transferred by the formula RR/(1+upper limit value RR), and the lower limit values were transferred by the formula RR/(1+lower limit value RR). The comparison of group rates was done by indirect comparison,  Z=difference between group rate-/〖KF(〗∑〖DD(〗n〖〗i=1〖DD)〗(standard error of group rate)2〖KF)〗. The heterogeneity was analyzed by I2.Results:Eighteen literatures of crosssectional studies were retrieved and the total sample size was 410 patients. The results of Meta analysis: (1) the summary RR of 3year overall survival of surgical patients with GCLM was 0.47 (95%CI: 0.37-0.60) while the summary 3year overall survival rate was 32.0% (95%CI: 0.27-0.38). (2)The summary RR of 5year overall survival of surgical patients with GCLM was 0.35 (95%CI: 0.27-0.45), summary RR of 5year overall survival rate was 25.9% (95%CI: 0.21-0.31). (3)The summary RR of overall recurrence of surgical patients with GCLM was 2.95 (95%CI: 2.23-3.88) while the summary overall recurrence rate was 74.7% (95%CI: 0.69-0.80). (4)The summary RR of remnant liver recurrence of surgical patients with GCLM was 1.39 (95%CI: 0.91-2.15) while the summary RR of remnant liver recurrence rate was 58.2%(95%CI: 0.48-0.68). (5)The summary 3year survival rate of surgical patients with GCLM and primary carcinoma serosal invasion was 32.9%(95%CI: 0.23-0.44), and summary 5year survival rate was 25.9%(95%CI: 0.16-0.40). The summary 3year survival rate of surgical patients with GCLM and without primary carcinoma serosal invasion was 47.9%(95%CI: 0.38- 0.58), and summary 5year survival rate was 38.3%(95%CI: 0.29-0.49). The summary 3year survival rate of surgical patients with synchronous hepatic metastases was 30.6%(95%CI: 0.24-0.38), and summary 5year survival rate was 24.2%(95%CI: 0.18-0.32). The summary 3year survival rate of surgical patients with metachronous hepatic metastases was 40.1%(95%CI: 0.3²-0.48), and summary 5year survival rate was 32.9%(95%CI: 0.25-0.41). The summary 3year survival rate of surgical patients with solitary metastatic hepatic carcinoma was 47.6%(95%CI: 0.40- 0.56), and summary 5year survival rate was 37.1%(95%CI: 0.26-0.48). The summary 3year survival rate of surgical patients with multiple metastatic hepatic carcinoma was 28.6%(95%CI: 0.18-0.42), and summary 5year survival rate was 15.3%(95%CI: 0.07-0.30). The summary 3year survival rate of surgical patients with GCLM and R0 resection was 28.6%(95%CI:0.19-0.40), and summary 5year survival rate was 20.0%(95%CI: 0.1²-0.32).  The summary 3year survival rate of surgical patients with GCLM and without R0 resection was 0.0, and summary 5year survival rate was 9.1%(95%CI: 0.03-0.25). The summary 3year survival rate of surgical patients with GCLM and resection margin<10 mm was 13.0%(95%CI: 0.05- 0.30), and summary 5year survival rate was 8.3%(95%CI: 0.0²-0.28). The summary 3year survival rate of surgical patients with GCLM and resection margin≥10 mm was 34.6%(95%CI: 0.21-0.52), and summary 5year survival rate was 34.6%(95%CI: 0.21-0.52). The summary 3year survival rate of surgical patients with GCLM and chemotherapy was 45.9%(95%CI: 0.29-0.64), and summary 5year survival rate was 29.1%(95%CI: 0.19-0.42). The summary 3year survival rate of surgical patients with GCLM and without chemotherapy was 38.7%(95%CI: 0.26-0.53), and the summary 5year survival rate was 25.4%(95%CI: 0.18-0.35). The 3year survival rate of surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases, solitary metastatic hepatic carcinoma, R0 resection and resection margin≥ 10 mm was statistically significantly higher than that of surgical patients with primary carcinoma serosal invasion, synchronous hepatic metastases, multiple metastatic hepatic carcinoma and resection margin<10 mm and without R0 resection  (Z=2.118, 1.999, 3.018, 5.295, 2.183, P<0.05). The 5year survival rate of surgical patients with solitary metastatic hepatic carcinoma and resection margin≥10 mm was statistically significantly higher than that of surgical patients with multiple metastatic hepatic carcinoma and resection margin<10 mm (Z=4.528, 2.819, P<0.05).
Conclusion:Overall longterm efficacy of surgical patients with GCLM is not good enough, and there is the better prognosis in the surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases, solitary metastatic hepatic carcinoma, R0 resection and resection margin≥10 mm.