探讨初始可切除性胃癌肝转移（GCLM）患者运用根治性及姑息性手术治疗的预后状况及其影响因素。

回顾性选取2021年1月至2024年12月在湖北中医药大学附属公安中医医院就诊的150例初始可切除性GCLM患者为研究对象，根据手术治疗方式将患者分为根治组（n=89）和姑息组（n=61），对比两组患者的预后状况及术后并发症，采用Kaplan-Meier法绘制生存曲线，通过Log-rank检验分析不同治疗方案对初始可切除性GCLM患者生存率的影响。采用单因素和多因素分析探讨影响预后的因素。

根治组中位总生存期为32.6个月，1、3年生存率分别为84.3%、44.9%；姑息组中位总生存期为18.4个月，1、3年生存率为62.2%、21.3%（P<0.05）。150例初始可切除性GCLM患者，预后良好包括那些能够进行完全手术切除且肝转移灶少、术后辅助治疗有效、肿瘤标志物水平较低的患者；预后不良包括肝转移灶多、无法完全切除、术后复发或转移、化疗反应差且标志物水平升高的患者。150例中预后良好60例、预后不良90例，预后良好组年龄、性别、吸烟史、饮酒史、胃原发肿瘤部位、胃原发肿瘤最大径、WHO分型、肝转移数目、肝转移分布、肝转移瘤最大径较预后不良组，差异无统计学意义（P>0.05）；预后良好组肿瘤中高分化程度、根治性手术的占比均高于预后不良组，转移瘤数目多发、腹膜转移、脉管侵犯均明显低于预后不良组（P<0.05）。Logistic回归分析显示，肿瘤低分化程度，肝转移瘤数目多发、腹膜转移、脉管侵犯均是影响初始可切除性GCLM患者运用根治性及姑息性手术治疗预后的危险因素，根治性手术是预后的保护因素（P<0.05）。两组术后并发症发生率比较，差异无统计学意义（χ²=0.180，P=0.672）。

对于初始可切除性GCLM，根治性手术治疗可显著延长生存期，但需严格排除肝转移瘤数目多、合并腹膜转移或脉管侵犯的高危患者。

To investigate the prognostic status and influencing factors of radical and palliative surgery in patients with initial resectable gastric cancer with liver metastasis (GCLM).

A total of 150 patients with initially resectable GCLM admitted to Gong'an Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine from January 2021 to December 2024 were selected as the study objects, and the patients were divided into radical treatment group (n=89) and palliative group (n=61) according to surgical treatment methods. The prognosis and postoperative complications of the two groups of patients were compared. The survival curves were plotted using the Kaplan-Meier method, and the effects of different treatment regimens on the survival rate of patients with initially resectable GCLM were analyzed by the Log-rank test. Univariate and multivariate analyses were used to explore the factors influencing prognosis.

The median overall survival for the curative group was 32.6 months, with 1-year and 3-year survival rates of 84.3% and 44.9%, respectively. For the palliative group, the median overall survival was 18.4 months, with 1-year and 3-year survival rates of 62.2% and 21.3% (P<0.05). Among 150 patients with initially resectable GCLM, the favorable prognosis group included those who underwent complete surgical resection with few liver metastases, effective postoperative adjuvant therapy, and lower levels of biomarkers. The unfavorable prognosis group included patients with multiple liver metastases, those who could not undergo complete resection, those with postoperative recurrence or metastasis, poor chemotherapy response, and elevated biomarker levels. Among the 150 cases, 60 had a good prognosis and 90 had a poor prognosis. Comparisons of age, gender, smoking history, alcohol history, primary gastric tumor location, maximum diameter of the primary gastric tumor, WHO classification, number of liver metastases, liver metastasis distribution, and maximum diameter of liver metastases between the two groups showed no statistically significant differences (P>0.05). The favorable prognosis group had higher proportions of tumors with moderate to high differentiation and curative surgeries than the unfavorable prognosis group. Additionally, the number of metastatic lesions, abdominal metastasis, and vascular invasion were significantly lower in the favorable prognosis group compared to the unfavorable prognosis group (P<0.05). Logistic regression analysis showed that poorly differentiated tumors, multiple liver metastases, abdominal metastasis, and vascular invasion were risk factors affecting the prognosis of initially resectable GCLM patients undergoing curative and palliative surgical treatments, with curative surgery being a protective factor for prognosis (P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ²=0.180, P=0.672).

For initially resectable GCLM, radical surgical treatment can significantly prolong survival, but high-risk patients with a large number of liver metastases, peritoneal metastasis or vascular invasion should be strictly excluded.