Clinical diagnosis of metastatic gastric tumors: clinicopathologic findings and prognosis of nine patients in a single cancer center.

Abstract

The clinical features of metastatic gastric tumors (MGTs) have not been well documented. We present a clinical series of nine patients with MGTs. Among 2579 patients with gastric tumors seen between 1992 and 2001, we studied 9 (0.3%) patients with MGT according to a prospective database. The MGTs were diagnosed based on findings in the surgical or endoscopic specimen, and patients with malignant lymphoma or direct invasion from adjacent organs were excluded from the study. MGTs were detected simultaneously with the primary tumors in three and afterward in six patients at 14 to 74 months. The primary tumors included one each of squamous cell carcinoma of the esophagus, signet-ring cell carcinoma of the breast, large-cell or small-cell carcinoma of the lung, renal cell carcinoma, hepatocellular carcinoma, squamous cell or epidermoid carcinoma of the uterus, and melanoma. Multiple organ metastases were present simultaneously in six patients. Although six patients underwent gastrectomy, macroscopic eradication of gastric metastatic disease was accomplished in only four, in whom a UICC R0 resection was possible in only two. Five patients were treated by chemotherapy with no apparent survival benefit. A median survival after MGT diagnosis was 170 days (range 16-892 days) for all cases, 384 days for those who underwent gastrectomy (n = 6), and 27 days for those without active treatment (n = 3) (p = 0.002). The cause of death was multiple organ metastases in most cases. Because multiple metastases are common, the prognosis of MGT is poor even after curative resection. MGT is likely to be a preterminal event, and surgical resection may be useful only for palliation.