Introduction: Brain metastasis in gastric cancer (GC) is a rare manifestation associated with poor prognosis and unfavorable outcomes. Identification of risk factors is essential for early detection and treatment. We investigated the incidence, risk factors, and prognostic factors of brain metastasis in GC patients. Methods: Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2018 were retrieved from the Surveillance, Epidemiology, and End-Results database. Overall survival (OS) was defined as the time from diagnosis to death from any cause or end of follow-up. Cancer-specific survival (CSS) was defined as the time from diagnosis to death due to GC or end of follow-up. Descriptive statistics, multivariate logistic regression, and Cox regression were applied using SPSS version 26. Kaplan Meier survival curves were constructed (Figure). Results: We included 7,960 patients with GC (Table). Brain metastasis was reported in 31 (0.39 %) patients. On logistic regression, patients who had undergone surgery were at reduced risk for brain metastasis (adjusted odds ratio (aOR) 0.086, P< 0.001). Increased risk of brain metastasis was reported in patients who had concurrent metastasis to bone (aOR 4.973, P < 0.001) and lung (aOR 5.816, P < 0.001). The median OS was significantly lower in patients with brain metastasis (5 months) compared to those without brain metastasis (21 months, P < 0.05). The median CSS was significantly lower in patients with brain metastasis (5 months) compared to those without brain metastasis (25 months, P < 0.05). On Cox regression, significantly reduced OS was reported in patients at T3 (AHR 7.549) and T4 stage (adjusted hazard ratio (aHR) 19.394). OS was prolonged in patients who had undergone surgery (aHR 0.043). CSS was significantly reduced in patients at T3 (aHR 6.234) and T4 stage (aHR 17.148). Patients who had undergone surgery had longer CSS (aHR 0.04). Conclusion: Metastasis to the brain was reported in only 0.39% of GC patients. Brain metastasis is associated with worse OS and CSS in GC, particularly in patients with advanced tumor stage and those who did not undergo surgery.Figure 1.: Kaplan Meier Survival Analysis for Gastric Cancer with and without Brain Metastasis. Table 1. - Baseline Characteristics of Patients with Gastric Cancer Features Brain Metastasis, n (%) No metastasis, n (%) P-value Total 31 (100) 7929 (100) Race 0.068 Caucasian 27 (87.1) 5390 (68.0) African American 2 (6.5) 850 (10.7) Other 2 (6.5) 1689 (21.3) Sex 0.709 Male 19 (61.3) 5122 (64.6) Female 12 (38.7) 2807 (35.4) Age, years 0.046* Less than 50 3 (9.7) 862 (10.9) 50-75 24 (77.4) 4476 (56.5) More than 75 4 (12.9) 2591 (32.7) T Stage 0.597 0 0 (0) 23 (0.29) 1 10 (32.2) 2478 (31.3) 2 1 (3.2) 1009 (12.7) 3 13 (41.9) 2775 (35.0) 4 7 (22.6) 1644 (20.7) N Stage 0.527 0 12 (38.7) 4034 (50.9) 1 12 (38.7) 2221 (28.0) 2 4 (12.9) 901 (11.4) 3 3 (9.7) 773 (9.7) Surgery < 0.001 Yes 2 (6.4) 4439 (56.0) No 29 (93.5) 3490 (44.0) Bone Metastasis < 0.001 Yes 10 (32.3) 231 (2.9) No 21 (67.7) 7698 (97.1) Liver Metastasis < 0.001 Yes 11 (35.5) 811 (10.2) No 20 (64.5) 7118 (89.8) Lung Metastasis < 0.001 Yes 10 (32.2) 222 (2.8) No 21 (67.7) 7707 (97.2)
Authors: Diana L. Franco, Mohammad Ebad Ur Rehman, Fatima Faraz, Zahoor Ahmed, Sajeel Saeed, Jawad Basit
DOI: https://doi.org/10.14309/01.ajg.0000863176.09867.c6
Publish Year: 2022
