Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6037
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
Patients with gastric or esophageal cancer have a high incidence of locoregional recurrence and distant metastases and therefore have limited survival. There are limited studies reporting on differences of the metastatic spreading according to the primary tumor location and histological subtype.
As upper gastrointestinal tract tumors are a heterogenous group, further improvement of survival probably lies within a more personalized treatment strategy. Also, early recognition of metastases is important to avoid futile locoregional treatments. Therefore, it is important to attain deeper knowledge on the different patterns of metastatic spreading and the factors that are instrumental in the determination of these patterns.
The aim of this study is to gain insight into the metastatic pattern of gastroesophageal cancer.
A nationwide retrospective autopsy study of patients with adenocarcinoma or squamous cell carcinoma (SCC) of the esophagus or stomach with metastases between 1990 and 2017 was performed. The metastatic pattern was analyzed according to the primary tumor location and histological subtype.
Metastatic disease was found in 268 esophageal and 331 gastric cancer patients that underwent an autopsy. In esophageal cancer, the most common metastatic locations were liver (56%), distant lymph nodes (53%) and lung (50%). Esophageal adenocarcinoma 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 adenocarcinoma 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 adenocarcinoma.
This autopsy study provides novel data on differences in the spread of distant metastases based on the primary tumor location and their histological subtypes in a large national autopsy cohort.
These results should be taken into account during preoperative staging, during follow-up and in future research.