Transcatheter Arterial Chemoembolization Combined With Hepatic Arterial Infusion Chemotherapy For Gastric Cancer With Liver Metastasis:A Clinical Retrospective Study

Objective:Gastric cancer progresses rapidly and has a poor prognosis after liver metastasis.Conventional transcatheter arterial chemoembolization(cTACE)combined with Hepatic arterial infusion chemotherapy(HAIC)is effective in the treatment of advanced gastric cancer with liver metastasis(GCLM)and can prolong the progression-free survival(PFS)and overall survival(OS).However,the studies of transcatheter arterial chemoembolization combined with hepatic artery infusion chemotherapy for gastric cancer with liver metastasis are rare.This study was conducted to investigate the efficacy,safety and prognostic factors of cTACE combined with HAIC in the treatment of advanced gastric cancer with liver metastases who were refractory to the first-line chemotherapy.Methods:Between May 2006 and January 2021,131 patients with GCLM after progression of first-line chemotherapy were included in this study.All patients received interventional therapy based on cTACE combined with HAIC.The primary end points were OS and PFS.The second end point was the safety of cTACE combined with HAIC.All treatment responses were evaluated according to the modified Response Evaluation Criteria in Solid Tumors(mRECIST).Treatment-related adverse reactions were evaluated by Common Terminology Criteria for Adverse Events(CTCAE 5.0).OS and PFS were analyzed by Kaplan-Meier,log-rank was used for univariate analysis,and Cox hazard model was used for multivariate analysis.Results:A total of 131 patients with GCLM who progressed on first-line systemic chemotherapy were included,of whom 1 patient was lost to follow-up and 130 patients were finally included.The patients were followed up regularly until January 2021,and the median follow up time was 10.0 months.In this study,the objective response rate(ORR)was 35.4%(46/130)and the disease control rate(DCR)was 76.2%(99/130).In this study,the median survival time(mOS)was 24.00 months after the diagnosis of gastric cancer,16.00 months after the diagnosis of liver metastases,10.0 months after the first interventional therapy;the median progression-free survival(mPFS)after the first interventional therapy was 5.0 months.The most common adverse reactions were nausea and vomiting(46/130,35.4%),hematological toxicity(33/130,25.4%),of which 5 cases were grade 3～4 hematological toxicity.Other adverse reactions included abnormal liver function,abdominal pain,fever and other non-specific reactions.Univariate analysis showed that the number of liver metastases(P=0.001)and HAIC regimen(FOLFOX group,P=0.043)were prognostic factors for the survival of patients with GCLM.The maximum diameter of liver metastases(diameter ≤3.0 cm,P=0.014)was a prognostic factor for the survival of patients with multiple liver metastases from gastric cancer.Multivariate analysis showed that the number of liver metastases was an independent prognostic factor for OS in patients with GCLM,and single liver metastases had a significant advantage in OS compared with patients with multiple liver metastases(18.0 months vs.9.0 months,HR:2.515,95%CI:1.402-4.512,P=0.002);the maximum diameter of liver metastases ≤3.0 cm(HR:1.641,95%CI:1.008-2.674,P=0.047)was an independent positive prognostic factor in patients with multiple liver metastases from gastric cancer.Conclusion:cTACE combined with HAIC is a safe and effective method for the treatment of patients with GCLM.The number of liver metastases is an independent prognostic factor for patients with GCLM.