Efficacy and feasibility of radiofrequency ablation for liver metastases from gastric adenocarcinoma

Figures & data

Figure 1. Flow chart of enrolled patients.

Table I.  Patient characteristics.

		Number of patients (%)
Variable		RFA (n = 20)	Chemotherapy only (n = 9)	p-value
Gender	Male	15 (75)	9 (100)
	Female	5 (25)	0 (0)	0.131
Age (median years)		57 (33–77)	60 (52–74)	0.269
Primary gastric cancer
T stage	T1	2 (10)	0 (0)	0.78
	T2	3 (15)	2 (22)
	T3	11 (55)	6 (67)
	T4	3 (15)	1 (11)
	NA	1 (5)	0 (0)
N stage	N0	2 (10)	1 (11)	0.88
	N1	4 (20)	3 (33)
	N2	9 (45)	4 (45)
	N3	4 (20)	1 (11)
	NA	1 (5)	0 (0)
Histological grade(differentiation)	Poorly	7 (35)	4 (44)	0.55
	Moderate	9 (45)	5 (56)
	Well	1 (5)	0 (0)
	NA	3 (15)	0 (0)
Tumour lesion	Upper body	4 (20)	3 (33)	0.64
	Mid body	4 (20)	1 (11)
	Lower body	10 (50)	5 (56)
	NA	2 (10)	0 (0)
Tumour size (cm, mean ± SD)		5.1 ± 2.3	6.1 ± 2.2	0.61
Hepatic metastasis
Number	1	13 (65)	1 (11)	0.02
	2	5 (25)	6 (67)
	3	2 (10)	2 (22)
Metastatic type	Synchronous	6 (30)	6 (67)	0.06
	Metachronous	14 (70)	3 (33)
Distribution	Unilobar	16 (80)	7 (78)	0.62
	Bilobar	4 (20)	2 (22)
Tumour size (cm, mean ± SD)		2.8 ± 1.4	4.5 ± 1.5	0.41
Chemotherapy after liver-directed Tx		15 (75)	–

NA, not available; SD, standard deviation; Tx, treatment

Table II.  Treatment outcome of individual patients.

			Primary gastric ca.				Liver metastases			RFA				Recur
No	age	sex	T	N	M	Initial stage	N	Loc	Chronicity	Size (cm)	Modality	CTx after RFA	Complete ablation	Recur	Pattern	Tx after recur	OS (mon)	PFS (mon)	Alive^a
1	57	M	4	2	0	IV	1	uni	meta	2.5	intraop	yes	yes	yes	Liver (S5)	RFA	48.1	23.2	no
2	61	M	4	3	1	IV	1	uni	syn	0.7	intraop	yes	yes	yes	Liver (multi)	CTx	37.3	3.6	no
3	36	M	3	3	1	IV	2	bi	syn	1.2	intraop	yes	yes	yes	Liver (multi)	CTx	3.7	0.8	no
4	45	F	3	1	1	IV	3	bi	syn	1.0	intraop	yes	yes	yes	Liver (S1)	CTx	69.9	7.6	no
5	64	M	3	2	1	IV	1	uni	syn	1.0	intraop	yes	yes	yes	Liver (multi)	no Tx	10.9	6.8	no
6	67	M	2	3	0	IV	1	uni	meta	3.5	intraop	yes	yes	no	–	–	9.8	9.8	yes
7	61	F	2	1	1	IV	1	uni	syn	2.0	intraop	yes	yes	no	–	–	4.3	4.3	yes
8	33	M	–	–	1	IV	1	uni	syn	0.9	intraop	yes	yes	no	–	–	45.2	45.2	yes
9	64	M	4	1	0	IV	2	uni	meta	4.0	intraop	no	yes	yes	Liver (S7)	RFA	30.7	10.8	no
10	34	F	3	2	0	IIIb	1	uni	meta	1.5	percut	yes	yes	yes	Liver (dome)	RFA	90.9	1.7	yes
11	71	M	1	0	0	Ia	2	bi	meta	3.5	percut	yes	yes	yes	Liver (S4)	RFA	27.3	1.1	no
12	65	F	3	2	0	IIIb	1	uni	meta	1.5	percut	yes	yes	yes	Liver, lung	CTx	20.7	3	no
13	63	M	1	0	0	Ia	1	uni	meta	4.0	percut	yes	yes	yes	Liver, peritoneum	CTx	53.5	19.8	no
14	57	M	3	2	0	IIIb	2	uni	meta	1.0	percut	yes	yes	yes	Liver, peritoneum	CTx	33.8	2.5	no
15	64	M	3	2	0	IIIb	2	uni	meta	4.0	percut	no	yes	yes	Liver, peritoneum	no Tx	5.7	1.5	no
16^b	49	M	3	1	0	IIIa	3	bi	meta	2.6	percut	no	no	yes	Liver, peritoneum	no Tx	2.9	0.9	no
17	66	M	3	2	0	IIIb	1	uni	meta	5.0	percut	no	yes	yes	Liver, lung	no Tx	5.0	4.4	no
18	77	M	2	3	0	IV	1	uni	meta	1.2	percut	yes	yes	no	–	–	3.4	3.4	yes
19	42	M	3	2	0	IIIb	1	uni	meta	1.8	percut	yes	yes	no	–	–	14.4	14.4	yes
20	66	F	3	2	0	IIIb	1	uni	meta	2.0	percut	no	yes	no	–	–	7.4	3.5	no

^aAlive at the time of analysis.

^bThe patients who showed incomplete ablation.

syn, synchronous; meta, metachronous; N, number; Loc, location; CTx, chemotherapy; Tx, treatment; OS, overall survival; PFS, progression-free survival; uni, unilateral lobe; bi, bilateral lobe; intraop, intraoperative; percut, percutaneous.

Table III.  Treatment modality in 14 recurred patients after RFA.

Relapse pattern	Treatment after relapse n (%)			Total
	Chemotherapy	RFA	No treatment
Intrahepatic relapse	2 (25)	4 (50)	2 (25)	8 (100)
Single	1 (12.5)	4 (50)	0 (0)	5 (62.5)
Multiple (≥ 4)	1 (12.5)	0 (0)	2 (25)	3 (37.5)
Extrahepatic relapse	0 (0)	0 (0)	0 (0)	0 (0)
Intrahepatic and systemic relapse	3 (50)	0 (0)	3 (50)	6 (100)

Figure 2. Overall survival and progression-free survival of patients treated with RFA.

Figure 3. Overall survival comparing patients who underwent RFA with sequential chemotherapy (n = 20) with patients who received chemotherapy only (n = 9). (31 months versus 7 months, hazard ratio, 0.24; p = 0.004).

Table IV.  Comparison of reports regarding liver-directed treatment for gastric adenocarcinoma with liver-only metastases.

Reference	Nation	Enroll period (years)	No of patients (n)	Syn/metachronous LM (n)	Single/Multiple LM	Prognostic factor	Adjuvant chemotherapy (n)	Median survival duration (months)	Overall survival (%)
									1 yr	3 yr	5 yr
Sakamoto Y et al. [4]	Japan	1985–2001 (17)	22	12/10	16/6	Number/size	8 (36%)	21.0	73.0	38.0	38
Okano K et al. [3]	Japan	1986–1999 (14)	19	13/6	10/9	Peritumoural fibrous psuedocapsule, histologic type	11 (58%)	21.0	77.0	34.0	34
Ambiru S et al. [28]	Japan	1975–1999 (25)	40	18/22	19/21	Time of thepatic metastases	13 (33%)	12.0	_	_	18
Sakamoto Y et al. [5]	Japan	1990–2005 (16)	37	16/21	21/16	Distribution/size of liver meta	6 (16%)	31	_	_	11
Koga R et al. [7]	Japan	1985–2005 (21)	42	20/22	29/13	Seroral invasion of primary tumour, number of liver meta	13 (31%)	34	76	48	42
Kim et al. (current study)	Korea	1995–2008 (14)	20	6/14	13/7	None	15 (75%)	30.7	66.8	40.1	16.1

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