Highlights
- •There is a significant difference in the spread patterns of intestinal gastric cancer compared to that of diffuse subtype.
- •Tumors in the gastroesophageal junction, lesser curvature, and antrum tend to spread to the gastrohepatic ligament and the omentum.
- •Presence of hepatic metastases does not affect overall survival predictability.
Abstract
Objective
We assessed differences in primary sites and spread patterns of the intestinal and
diffuse subtypes of gastric carcinoma. We also compared survival outcomes based on
spread patterns.
Materials and methods
For this retrospective IRB-approved study, our institutional imaging database was
mined for patients with gastric cancer. We included 99 treatment-naïve patients. Patient
demographics, pathologic data, tumor classification, primary tumor site, and metastasis
sites were recorded. Pearson's chi-squared test was used to correlate tumor pathology
with metastatic sites. Kaplan–Meier survival curves were compared between baseline
metastatic types. A heat map was created based on the relative frequencies of metastatic
sites for each primary tumor site.
Results
Of the 99 patients, 66 patients had intestinal and 33 had diffuse gastric carcinoma.
The intestinal subtype was significantly associated with hepatic metastases (p < 0.001). Diffuse subtype was associated with peritoneal metastases, including omental
metastases (p < 0.006), gastrosplenic ligament involvement (p < 0.004), and mesocolonic implants (p < 0.008). Patients with primary gastric tumors occurring at the greater curvature
had longer overall survival than those with primary sites at the antrum, GE junction
and lesser curvature (p = 0.0015). Patients with peritoneal metastases had a significantly shorter overall
survival than patients without peritoneal metastases (p < 0.001). Patients without mesocolon, gastrohepatic ligament, and gastrosplenic ligament
involvement had a better survival (p = 0.005, p = 0.0002, and p = 0.0005, respectively). Presence of hepatic metastases had no effect on survival
(p = 0.16).
Conclusion
Recognizing distinctive spread patterns for intestinal versus diffuse gastric carcinoma
can aid radiologists in diagnosis and guide clinical management.
Keywords
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Article info
Publication history
Published online: March 03, 2019
Accepted:
March 1,
2019
Received in revised form:
February 12,
2019
Received:
November 4,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
