Prognostic value of the site of distant metastasis and of surgical interventions in metastatic gastric cancer: a population-based study

Abstract

Background: The studies on the prognostic significance of site-specific distant metastasis, multiple-site metastases, and the impact of surgery of the primary tumor and metastatic lesion on survival outcomes of patients with metastatic gastric cancer (GC) remain elusive. Therefore, the present study aimed to investigate the prognostic significance of the site of distant metastasis among patients with metastatic GC. Furthermore, the effect of surgery of the primary tumor and metastatic lesion on the prognosis of metastatic GC was also analyzed.Methods: The data of 4,221 eligible patients, who were diagnosed with metastatic GC between 2010 and 2015, were identified from the Surveillance Epidemiology and End Results (SEER) database. Multivariate logistic regression analysis was performed to assess the association between potential prognostic factors, including the site of metastasis and surgery, and survival of patients with metastatic GC. Overall survival (OS) and cause-specific survival (CSS) were determined using the Kaplan-Meier survival curves and differences were assessed using the Log-rank test.Results: A total of 4,221 eligible GC patients with definite organ metastases were identified. Of these, 3312 GC patients had single-site metastasis while 909 patients had multiple-site metastases. GC Patients with single-site metastasis of liver or lung exhibited better CSS and OS compared to GC patients with bone metastasis. Furthermore, GC patients with liver metastasis were benefitted from surgery of both the primary and metastatic lesions, while GC patients with lung metastasis were benefited from surgery of metastasis resection only. Multivariate Cox regression analysis revealed that GC patients with single-site metastasis, well-differentiated tumors, and GC patients who underwent surgery of the primary tumor and those who received chemotherapy exhibited favorable prognosis.Conclusions: The site of metastasis was an independent prognostic factor for metastatic GC. Surgery had survival benefits in certain cases of metastatic GC; however, further studies are warranted to clarify these benefits in carefully selected patients.