Brain metastasis from gastric adenocarcinoma: A large comprehensive population-based cohort study on risk factors and prognosis

Lei Huang; Lei Wang; Yan Shi; Yajie Zhao; Chenying Xu; Jun Zhang; Weiguo Hu

doi:10.3389/fonc.2022.897681

Brain metastasis from gastric adenocarcinoma: A large comprehensive population-based cohort study on risk factors and prognosis

Front Oncol. 2022 Oct 18:12:897681. doi: 10.3389/fonc.2022.897681. eCollection 2022.

Authors

Lei Huang^{1

2}, Lei Wang^{2

3}, Yan Shi¹, Yajie Zhao^{2

4}, Chenying Xu^{2

4}, Jun Zhang^{1

5}, Weiguo Hu^{2

4}

Affiliations

¹ Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁵ State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Aims: Although brain metastasis from gastric adenocarcinoma (GaC) is rare, it may significantly affect survival and quality of life. The aim of this large, comprehensive, population-based cohort investigation was to investigate factors that were associated with brain metastasis from GaC and to explore the prognostic factors and time-dependent cumulative mortalities among cases with GaC and brain involvement.

Methods: Population-based information on cases with GaC diagnosed from 2010 to 2016 was obtained from a large-scale database. Factors that were associated with brain metastasis were investigated utilizing multivariable logistic regression. Time-dependent tumor-specific mortalities of cases with GaC and brain involvement were then computed utilizing the cumulative incidence functions (CIFs), and mortalities were compared between subgroups utilizing Gray's test. Factors that were associated with death were further evaluated utilizing multivariable Fine-Gray subdistribution hazard regression.

Results: Together, 28,736 eligible cases were included, which comprised 231 (1%) cases with brain metastasis and 10,801 (38%) with metastasis to other sites, encompassing a follow-up of 39,168 person-years. Brain metastasis occurred more often among younger patients (within overall cancers), in cases with stomach cardia tumors, within cases with signet-ring cell carcinoma (within overall cancers), and within cases with positive lymph nodes (within overall tumors); it was less often detected among black people. Brain involvement was associated with more lung and bone metastases. The median survival time of cases having brain metastasis was only 3 months; the 6- and 12-month tumor-specific cumulative mortalities were 57% and 71%, respectively. Among cases with GaC and brain metastasis, those with gastric cardia cancers (when receiving radiotherapy), those undergoing resection, and those receiving chemotherapy had lower mortality risks, while younger patients (when receiving chemotherapy or radiotherapy) and people with positive lymph nodes (when receiving radiotherapy) had higher death hazards.

Conclusion: Among patients with GaC, brain metastasis was correlated with several clinical and pathological variables, including ethnicity, age, cancer histology, location, lymph node involvement, and metastases to other sites. Cases having brain metastasis had poor survival that was correlated with age, cancer location, lymph node metastasis, and management. These findings offer vital clues for individualized patient care and future mechanistic explorations.

Keywords: Fine-Gray sub-distribution hazard regression; brain metastasis; competing risk analysis; cumulative incidence function; gastric adenocarcinoma; large population-based cohort study; survival.