Verstegen MHP, Harker M, van de Water C, van Dieren J, Hugen N, Nagtegaal ID, Rosman C, van der Post RS. Metastatic pattern in esophageal and gastric cancer: Influenced by site and histology. World J Gastroenterol 2020; 26(39): 6037-6046 [PMID: 33132653 DOI: 10.3748/wjg.v26.i39.6037]
Corresponding Author of This Article
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
Research Domain of This Article
Pathology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
The aim of this study is to gain insight into the metastatic pattern of gastroesophageal cancer.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
These results should be taken into account during preoperative staging, during follow-up and in future research.
