Lung metastases in metastatic gastric cancer: Pattern of lung metastases and clinical outcome

Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, 135-710, Korea.
Gastric Cancer (Impact Factor: 3.72). 10/2011; 15(3):292-8. DOI: 10.1007/s10120-011-0104-7
Source: PubMed


There are only limited data regarding pulmonary metastasis from gastric cancer. Therefore, we analyzed large series of gastric cancer with pulmonary metastasis and analyzed their clinical characteristics and treatment outcome to enhance perception of metastatic gastric cancer.
Of 20,187 advanced gastric cancer patients treated between 1995 and 2007, 193 (0.96%) were identified to have pulmonary metastasis from gastric cancer. The pulmonary lesions were detected at chest computed tomography (CT) scan or plain chest X-ray and/or abdominal pelvic CT scan covering the lower part of the lungs, and were divided into three patterns: lymphangitic, hematogenous, and pleural.
The most frequently observed pattern of lung metastasis was hematogenous metastasis (52.3%) followed by pleural (35.2%) and lymphangitic (26.4%). Patients who had hematogenous pulmonary metastasis were significantly associated with hepatic metastasis (p = 0.004) and male sex (p = 0.012). Patients with lymphangitic metastasis were significantly associated with concomitant bone (p = 0.010) and bone marrow (p = 0.029) metastasis. In case of pleural metastasis, it was positively correlated with gastrectomy history (p = 0.015) and the presence of peritoneal metastasis (p = 0.020). After a median follow-up duration of 87 (9-162) months, the median survival after diagnosis of pulmonary metastasis was 4 (0-67) months.
The most frequently observed pattern of lung metastasis was hematogenous metastasis (52.3%) followed by pleural (35.2%) and lymphangitic (26.4%) in gastric cancer patients. Among gastric cancer patients with lung metastases, patients with pleural metastasis or lymphangitic metastasis had shorter survival with 1.5-2-fold increased risk of deaths.

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    • "All these findings suggest that there may be a relationship between bone and bone marrow metastasis, and possibly between poor differentiation and unusual metastatic sites, including the bone and bone marrow. Kong et al.17 reported that there were 193 (0.96%) patients with pulmonary metastases among 20,197 patients with advanced gastric cancer; further, 34 (17%) of the patients with lung metastasis also had bone metastasis and 11 (5.7%) patients had bone marrow metastasis as well as lung metastasis. Besides, 58% of the patients had poorly differentiated or signet ring cell histopathology. "
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