Metastatic pattern in esophageal and gastric cancer: Influenced by site and histology

doi:10.3748/wjg.v26.i39.6037

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Oct 21, 2020; 26(39): 6037-6046
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6037

Metastatic pattern in esophageal and gastric cancer: Influenced by site and histology

Moniek HP Verstegen, Mitchell Harker, Carlijn van de Water, Jolanda van Dieren, Niek Hugen, Iris D Nagtegaal, Camiel Rosman, Rachel S van der Post

Moniek HP Verstegen, Mitchell Harker, Niek Hugen, Camiel Rosman, Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands

Carlijn van de Water, Iris D Nagtegaal, Rachel S van der Post, Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands

Jolanda van Dieren, Department of Gastroenterology Oncology, Netherlands Cancer Institute, Amsterdam 1066 CX, Netherlands

Author contributions: Verstegen MHP, Rosman C, Nagtegaal ID and van der Post RS designed the research; Verstegen MHP, Harker M and van der Post RS analyzed the data; Verstegen MHP and van der Post RS drafted the manuscript; van de Water C prepared the figures; All authors contributed and critically revised the manuscript for important intellectual content; all authors have approved the final version of this manuscript.

Institutional review board statement: This type of study does not require approval from an ethics committee under Dutch law. Please also see the attached document.

Conflict-of-interest statement: None to declare.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [chella.vanderpost@radboudumc.nl]. Consent was not obtained but the presented data are anonymized and risk of identification is low.

Corresponding author: Moniek HP Verstegen, MD, Research Fellow, Department of Surgery, Radboud Institute of Health Sciences, Radboud University Medical Center, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, Netherlands. moniek.verstegen@radboudumc.nl

Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: June 18, 2020
Revised: August 28, 2020
Accepted: September 5, 2020
Article in press: September 5, 2020
Published online: October 21, 2020
Processing time: 146 Days and 1.6 Hours

Abstract

BACKGROUND

Detailed information on metastatic patterns in of patients with esophageal and gastric cancer is limited. Early recognition of metastases is important to avoid futile locoregional treatments. Furthermore, knowledge on metastatic patterns is necessary for further development of personalized treatment modalities.

AIM

To gain insight into the metastatic pattern of gastroesophageal cancer.

METHODS

A nationwide retrospective autopsy study of 3876 patients with adenocarcinoma (AC) or squamous cell carcinoma (SCC) of the esophagus or stomach between 1990 and 2017 was performed. Only patient with metastases were included for analysis. The metastatic pattern was analyzed according to the primary tumor location and histological subtype.

RESULTS

Metastatic disease was found in 268 esophageal and 331 gastric cancer patients. In esophageal cancer, the most common metastatic locations were liver (56%), distant lymph nodes (53%) and lung (50%). Esophageal AC showed more frequently metastases to the peritoneum and bone compared with esophageal SCC. In gastric cancer, the most common metastatic locations were distant lymph nodes (56%), liver (53%) and peritoneum (51%). Intestinal-type AC of the stomach showed metastases to the liver more frequently, whereas metastases to the bone, female reproductive organs and colorectum were observed more frequently in diffuse-type gastric AC.

CONCLUSION

This study showed differences in metastatic patterns of patients with esophageal and gastric cancer according to the primary tumor location and histological subtype.

Keywords: Esophageal cancer; Gastric cancer; Metastases; Histology; Gastroesophageal junction; Adenocarcinoma; Carcinoma; Squamous cell

Core tip: In this nationwide retrospective autopsy study, the metastatic pattern of 599 patients with metastases of primary adenocarcinoma or squamous cell carcinoma of the esophagus or stomach were evaluated. Differences in metastatic patterns of these patients were found according both to the primary tumor location as well as the histological subtype. This study provides robust data regarding metastatic patterns in esophageal and gastric cancer patients. Knowledge of metastatic patterns is helpful during preoperative staging, follow-up and in future research.