Metachronous Liver Metastasis from Early Gastric Cancer

Early gastric cancer (EGC) has an excellent prognosis, but tumors recur in some patients even after apparently successful treatment. Among recurrent sites, the liver is one of the most common. In this study, we investigated clinicopathological features and factors predicting the development of liver metastasis from EGC. We examined the medical records of 2,707 consecutive patients who underwent open gastrectomy for EGC (pT1; m, sm) between 1991 and 2005. We assessed clinicopathological features and predictive factors for EGC metastasis in the liver. Fifteen (0.6%) of the 2,707 patients developed liver metastasis. All primary gastric tumors of patients with liver recurrence demonstrated invasion to the submucosal layer. Macroscopically, nine patients had elevated-type and six depressed-type. Nodal metastasis was documented in seven patients (47%). Lymphatic and vascular involvements were seen in 11 (73%) and 7 (47%) patients, respectively. Multivariate analysis of patients with submucosal invasion revealed macroscopic elevated type and vascular involvement to be independent risk factors for liver metastasis. With submucosal cancer, the macroscopic elevated type and vascular involvement are significant predictive factors for EGC recurrence in the liver.