Peritoneal metastasis in relation to outcome and therapeutic strategy in gastric cancer

Jia Wei, Yang Yang, Juan Du, Zhengyun Zou, Yaping Zhang, Nandie Wu, Qing Wang, Ling Yuan, Baorui Liu


Background: The prognosis of locally advanced and metastatic gastric cancer remains dismal. The aim of this study was to investigate the patterns of recurrence or metastasis of advanced gastric cancer and determine the factors associated with survival, which may help in identifying effective treatment strategies.
Methods: A retrospective analysis of 349 patients with stage III/IV gastric cancer was performed. The relationships between metastasis patterns and clinicopathological characteristics and overall survival were evaluated.
Results: Peritoneal metastasis was detected as any part of the metastasis/recurrence pattern in
219 patients (62.8%), while distant sites were involved in 208 patients (59.6%). 81.1% of the patients developed metastasis in peritoneal cavity (peritoneal or liver) at the time of recurrence or diagnosis. Stage III patients with locoregional recurrence (LR) had longer overall survival time than those with peritoneal or distant recurrence (DR) (21 vs. 15 months, HR: 0.628; P=0.047), while stage IV patients with peritoneal metastasis had shorter survival (7.5 vs. 14 months) and a higher risk of death (HR: 2.026; P=0.004).
Conclusions: Peritoneal metastasis appears to be the most common pattern and is associated with poor prognosis in gastric cancer patients. Effective regional treatment is important to guide appropriate further therapy in advanced gastric cancer patients.