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Association Between Metastatic Pattern and Prognosis in Stage IV Gastric Cancer: Potential for Stage Classification Reform

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study aims to clarify the association between metastatic pattern and prognosis in stage IV gastric cancer, with a focus on patients presenting with metastases limited to nonregional lymph nodes.

Methods

In this retrospective cohort study, the National Cancer Database was used to identify patients ≥ 18 years of age diagnosed with stage IV gastric cancer between 2016 and 2019. Patients were stratified according to pattern of metastatic disease at diagnosis: nonregional lymph nodes only (“stage IV-nodal”), single systemic organ (“stage IV-single organ”), or multiple organs (“stage IV-multi-organ”). Survival was assessed by Kaplan-Meier curves and multivariable Cox models in unadjusted and propensity score-matched samples.

Results

Overall, 15,050 patients were identified, including 1,349 (8.7%) stage IV-nodal patients. Most patients in each group received chemotherapy [68.6% of stage IV-nodal patients, 65.2% of stage IV-single organ patients, and 63.5% of stage IV-multi-organ patients (p = 0.003)]. Stage IV-nodal patients exhibited better median survival (10.5 months, 95% CI 9.7–11.9, p < 0.001) than single organ (8.0, 95% CI 7.6–8.2) and multi-organ (5.7, 95% CI 5.4–6.0) patients. In the multivariable Cox model, stage IV-nodal patients also exhibited better survival (HR 0.79, 95% CI 0.73–0.85, p < 0.001) than single organ (reference) and multi-organ (HR 1.27, 95% CI 1.22–1.33, p < 0.001) patients.

Conclusions

Nearly 9% of clinical stage IV gastric cancer patients have their distant disease confined to nonregional lymph nodes. These patients were managed similarly to other stage IV patients but experienced a better prognosis, suggesting opportunities to introduce M1 staging subclassifications.

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Data availability

The National Cancer Database is a nationwide clinical surveillance resource oncology data set that captures 72% of all newly diagnosed malignancies in the U.S. annually and is a joint project of the American Cancer Society and the American College of Surgeons. The American College of Surgeons has a data use agreement with each of its Commission on Cancer accredited hospitals. Data access can be requested from the American College of Surgeons.

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Acknowledgement

Not applicable.

Funding

The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Peter L. Zhan MD, Theresa Ermer MD, Matthew D. Pichert MD, MPH, Andrew X. Li MD, Richard C. Maduka MD, Brooks V. Udelsman MD, MHS & Daniel J. Boffa MD, MBA, FACS

  2. Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Maureen E. Canavan PhD, MPH

  3. Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076, Tübingen, Germany

    Attila Nemeth MD

Authors
  1. Peter L. Zhan MD
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  2. Maureen E. Canavan PhD, MPH
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  3. Theresa Ermer MD
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Contributions

Peter Zhan: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing—original draft, Writing—review and editing. Maureen Canavan: Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing—review and editing. Theresa Ermer: Investigation, Methodology, Visualization, Writing—review and editing. Matthew Pichert: Conceptualization, Investigation, Methodology, Visualization, Writing—review and editing. Andrew Li: Investigation, Methodology, Visualization, Writing—review and editing. Richard Maduka: Investigation, Visualization, Writing—review and editing. Attila Nemeth: Conceptualization, Methodology, Writing—review and editing. Brooks Udelsman: Conceptualization, Methodology, Writing—review and editing. Daniel Boffa: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing—original draft, Writing—review and editing.

Corresponding author

Correspondence to Daniel J. Boffa MD, MBA, FACS.

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Disclosure

Dr. Boffa reports non-financial support from Epic Sciences, outside the submitted work. Dr. Boffa was also on an advisory panel for Iovance unrelated to this work. None of the other authors have conflicts of interest to disclose.

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Zhan, P.L., Canavan, M.E., Ermer, T. et al. Association Between Metastatic Pattern and Prognosis in Stage IV Gastric Cancer: Potential for Stage Classification Reform. Ann Surg Oncol 30, 4180–4191 (2023). https://doi.org/10.1245/s10434-023-13287-9

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