Metastatic spread in patients with gastric cancer

Abstract

BackgroundThe epidemiology of metastatic gastric cancer is unexplored because cancer registries seldom cover metastatic involvement apart from “present or not”. We used a novel approach by utilizing Swedish registers to assess metastatic spread in gastric cancer. To our knowledge, this is the first nationwide description of metastases in gastric cancer.ResultsThe most common sites of metastasis were liver (in 48% of metastatic cancer patients), peritoneum (32%), lung (15%), and bone (12%). Metastases to the lung, nervous system, and bone were more frequent in cardia cancer and men, whereas non-cardia cancer more frequently metastasized within the peritoneum. Signet ring adenocarcinomas more frequently metastasized within the peritoneum, bone and ovaries, and less frequently to the lungs and liver compared with generic adenocarcinoma. The liver and the peritoneum were commonly single metastases while lung metastases occurred frequently together with liver metastases. The median survival in metastatic gastric cancer was 3 months, worst among those with bone and liver metastases (2 months).MethodsA total of 7,559 patients with gastric cancer were identified. Metastatic patterns and survival depending on sex, age, stage, anatomical location (cardia and non-cardia), and histological type were assessed.ConclusionsThe patterns of metastasis differ notably depending on histological type. Cardia cancer exhibits a completely different metastatic behavior than non-cardia cancer. Awareness of the differing patterns may guide in tailored diagnosis of metastases. Survivors from cardia cancer would benefit from increased surveillance of extraperitoneal metastases. Bone metastases should be considered in patients with signet ring adenocarcinoma if symptoms emerge.

Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed

“…The present guidelines report a lack of evidence for recommending a curative approach in metastatic gastric cancer. The liver is the most common site for metastases in patients with gastric cancer [18]. The reported rate of liver resection, however, is less than 1% due to the multiple, bilateral, and extrahepatic nature of the disease [15,19].…”

Gastric Cancer Patients with Bone Marrow Metastasis: A Single-Center Experience and Review of the Literature

“…Although the most common sites of metastasis in metastatic gastric cancer are the liver and peritoneum [2] , the most frequent synchronous site of bone marrow metastases in stomach cancer is bone, and liver and peritoneal metastases are much less common. In a study by Kim et al [9] , the most common synchronous metastasis regions were the bone (31/39), lymph node (17/39), peritoneum (15/39), and lungs (9/39).…”

“…Metastasis in gastric cancer is usually observed in the liver, peritoneum, and lymph nodes and less frequently in ovaries, lungs, central nervous system, and bone. [2] Bone marrow is a rare region for metastasis and usually reported as case reports and case series in the literature. Bone marrow involvement in gastric cancer as in all solid tumors associated with worse prognosis.…”

Current perspectives on hyperthermic intraperitoneal chemotherapy in gastric cancer

“…2 Gastric cancer is more common in males by a ratio of 1.65:1 and it kills males at a significantly higher rate than females (4.3:1). 3 Gastric cancer metastasizes aggressively, with the most common sites of gastric cancer metastases being: liver (48%), peritoneum (32%), lung (15%), and bone (12%). 3 Metastatic spread to the peritoneum carries a particularly poor prognosis: 5-year survival is ~4%.…”

“…3 Gastric cancer metastasizes aggressively, with the most common sites of gastric cancer metastases being: liver (48%), peritoneum (32%), lung (15%), and bone (12%). 3 Metastatic spread to the peritoneum carries a particularly poor prognosis: 5-year survival is ~4%. 4 Comparatively, gastric cancer without peritoneal metastases has an estimated 5-year survival rate of 29%.…”