Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

Abstract

BackgroundGastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.MethodsWe conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.ResultsSeventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.ConclusionsClinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.

Metastatic stomach lymphoepithelioma-like carcinoma and immune checkpoint inhibitor therapy: A case report

“…First, what is the pathway through which lung cancer metastasizes to the stomach? Although gastric metastasis from lung cancer is rare, it can spread to the gastrointestinal tract through hematogenous and lymphatic routes[ 13 ]. Based on the findings in the positive LN, which was consistent with those in the stomach lesions, we believe that this patient’s gastric metastasis was through the lymphatic pathway.…”

Endoscopic manifestations and treatment outcomes of asymptomatic gastric metastases from primary lung adenocarcinoma: Report of two cases

“…Gastric metastasis is uncommon for lung cancer in the clinic. Metastatic lesions may develop at any site of the stomach, mainly locating in the middle and upper thirds ( 11 , 12 ), and solitary gastric metastases are more common than multiple metastases ( 13 ). The endoscopic manifestations of gastric metastases may be diverse and the most common endoscopic appearance is submucosal mass with or without ulceration, and the ulceration at the apex of the submucosal mass usually be described as volcano-like or umbilicated ( 7 , 11 ).…”

“…The present study further reported the characteristics of small gastric metastases under BLI-ME; the microvascular and microsurface patterns of the covering mucosa may be regular or irregular, and the demarcation line between lesion and normal mucosa may exist or not correspond to the development stage of metastases; however, in the present study, certain common characteristics between the two cases were found under BLI-ME, such as an obviously widened IP and extended SECN, indicating that lesions developed beneath the superficial epithelium. These above endoscopic characteristics may be explained by the growth pattern of metastasis from a distant primary cancer; cancerous cells traveling through the blood or lymph system usually disseminate into the gastric submucosal layer first and then develop as a submucosal lesion ( 12 , 16 ), with further growth it may break through the covered epithelium and present as a central defection of the mucosa, or even erosion and ulcer. Endoscopic ultrasonography (EUS) has been widely used in the diagnosis and management of gastrointestinal neoplasms, particularly in gastric subepithelial lesions due to its excellent capability in evaluating the originating layer, echo level and internal echo pattern ( 17 ).…”

“…Endoscopic ultrasonography (EUS) has been widely used in the diagnosis and management of gastrointestinal neoplasms, particularly in gastric subepithelial lesions due to its excellent capability in evaluating the originating layer, echo level and internal echo pattern ( 17 ). As for gastric metastases, EUS may identify the hypoechoic and demarcated mass originating from the muscular or submucosal layer ( 12 , 18 ), EUS-guided tissue acquisition and the following immunohistochemical examination may provide a reliable method to identify gastric metastases ( 19 , 20 ).…”

“…The systemic treatment outcomes of primary lung cancer with gastric metastasis have been previously reported, but the focus was on the therapeutic effect on the primary tumor rather than the gastric metastatic lesions ( 10 ). To the best of our knowledge, only one previous study reported the systemic treatment outcomes of gastric metastasis from lung cancer; the gastric metastasis exhibited complete regression after 3 months of oral treatment with Osimertinib ( 12 ). This is in accordance with the cases of the present study and it may suggest that gastric metastases respond well to systemic treatment.…”