Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 11, Number 8, August 2019, pages 600-608


Gastrectomy Alone or in Combination With Hepatic Resection in the Management of Liver Metastases From Gastric Cancer: A Systematic Review Using an Updated and Cumulative Meta-Analysis

Figures

Figure 1.
Figure 1. Flow diagram of the search strategy.
Figure 2.
Figure 2. a) Traditional meta-analysis of synchronous/metachronous metastases demonstrates that significantly less metachronous metastases were included compared to synchronous metastases. b) Cumulative meta-analysis of synchronous/metachronous metastases depicts two time periods, one from 1994 to 2014 when nonsignificant differences were demonstrated and a second from 2015 until present when it was demonstrated that significantly less metachronous metastases compared to synchronous cases were included.
Figure 3.
Figure 3. a) Traditional meta-analysis of solitary/multiple metastases demonstrates that significantly less multiple metastases were included compared to solitary metastases. b) Cumulative meta-analysis of solitary/multiple metastases depicts two time periods, one from 1994 to 2003 when nonsignificant differences were demonstrated and a second from 2003 until present when it was demonstrated that significantly less multiple metastases compared to solitary cases were included.
Figure 4.
Figure 4. Forest plot depicting 1-, 2-, 3-, 5-year overall survival of gastrectomy plus hepatectomy versus gastrectomy alone. It is depicting that the gastrectomy plus hepatic resection cohort demonstrated significantly better survival benefits compared to gastrectomy alone.

Table

Table 1. Outcomes of Interest
 
Outcome of interestNumber of studies and patients (%; events/total)Statistical method, estimated effect, 95% CIP valueI2 (%)
OS: overall survival; MD: mean difference; HR: hazard ratio; OR: odds ratios.
Age4, 244MD = -2.40 (-6.13 to 1.34)0.2357
Synchronous metastases4, 206 (54%; 56/104) (51%; 52/102)OR = 0.42 (0.02 to 8.50)0.5789
Metachronous metastases4, 206 (28%; 29/104) (29%; 30/102)OR = 1.72 (0.86 to 3.43)0.1285
Unilobar metastases6, 430 (58%; 92/159) (25%; 67/271)OR = 3.88 (2.43 to 6.19)< 0.0010
Bilobar metastases6, 430 (26%; 41/159) (49%; 133/271)OR = 0.27 (0.08 to 0.91)0.0483
Solitary metastases5, 320 (52%; 64/124) (36%; 71/196)OR = 2.98 (0.95 to 9.37)0.0670
Multiple metastases5, 320 (33%; 41/124) (66%; 129/196)OR = 0.17 (0.04 to 0.80)0.0283
1-year OS9, 637HR = 0.52 (0.39 to 0.69)< 0.00139
2-year OS4, 397HR = 0.85 (0.74 to 0.97)0.0144
3-year OS9, 637HR = 0.80 (0.72 to 0.90)0.00358
5-year OS7, 452HR = 0.83 (0.78 to 0.90)< 0.0010
Subgroup analysis East versus West
1-year OS East6, 306HR = 0.42 (0.28 to 0.65)< 0.00134
1-year OS West3, 331HR = 0.63 (0.43 to 0.91)0.0147
2-year OS West3, 331HR = 0.85 (0.71 to 1.01)0.0753
2-year OS East1, 66HR = 0.80 (0.65 to 1.00)0.050
3-year OS East6, 306HR = 0.78 (0.70 to 0.86)< 0.0010
3-year OS West3, 331HR = 0.85 (0.69 to 1.05)0.1367
5-year OS East5, 272HR = 0.84 (0.78 to 0.91)< 0.0015
5-year OS West2, 180HR = 0.80 (0.68 to 0.94)0.0080