Metastatic spread in patients with gastric cancer

Matias Riihimäki, Akseli Hemminki, Kristina Sundquist, Jan Sundquist, Kari Hemminki, Matias Riihimäki, Akseli Hemminki, Kristina Sundquist, Jan Sundquist, Kari Hemminki

Abstract

Background: The 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.

Results: The 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).

Methods: A 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.

Conclusions: The 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.

Keywords: epidemiology; gastric cancer; metastasis.

Conflict of interest statement

AH is shareholder of Targovax AS. AH is employee and shareholder in TILT Biotherapeutics, Ltd. All remaining authors have declared no conflicts of interest.

Figures

Figure 1. Frequency of lung, peritoneal, and…
Figure 1. Frequency of lung, peritoneal, and liver metastases in patients with gastric cancer, depending on how many metastases were present
Panels (A, C, and E) display trend over stages, and panels (B, D, and F) display trend over the age at diagnosis of patients. Dotted line: one metastasis, gray line: two metastases, black line: three or more metastases. 100% = All patients with metastases. P-value for difference between stage or age.
Figure 2. Survival curves in metastatic gastric…
Figure 2. Survival curves in metastatic gastric cancer
In panel (A) comparison by T stage. In panel (B) comparison by N stage. In panel (C) comparison by site of metastasis.

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Source: PubMed

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