Seval ORMAN, Hamit BAL, Sedat YILDIRIM, Miray AYDOĞAN, Ezgi TÜRKOĞLU, Utku Dönem GÜNDOĞDU, Hatice ODABAŞ, Nedim TURAN
The European Research Journal - 2026;12(8):912-924
Objective: Metastatic gastric cancer is a biologically heterogeneous disease with a poor prognosis. Although the presence of distant metastasis defines advanced disease, the prognostic impact of specific metastatic patterns remains unclear. This study aimed to evaluate the association between metastatic patterns and overall survival in patients with metastatic gastric cancer. Methods: In this retrospective single-centre study, 292 patients with histopathologically confirmed metastatic gastric cancer were included. Metastatic sites were evaluated using computed tomography, magnetic resonance imaging, and/or positron emission tomography. Overall survival (OS) was analysed using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors were assessed through univariate and multivariate Cox proportional hazards regression models. Results: The median OS for the entire cohort was 10 months (95% CI, 9.3-12.0). The most common sites of metastasis were non-regional lymph nodes (78.8%), liver (49.7%), and peritoneum (30.8%). Peritoneal metastasis was associated with significantly worse survival in unadjusted Kaplan-Meier analysis (9.5 vs 11 months, P < 0.001), whereas other metastatic sites were not significantly associated with OS. No significant difference in OS was observed between patients with single-site and multiple-site metastases (P=0.31). In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG) and prior gastrectomy were identified as independent prognostic factors, while the impact of metastatic site did not remain statistically significant. Conclusion: Metastatic gastric cancer exhibits substantial heterogeneity in survival outcomes according to the distribution of metastatic sites. Peritoneal involvement was associated with worse survival in unadjusted analyses and may represent a clinically relevant marker of adverse prognosis. Including site-specific metastatic information in prognostic assessments may contribute to improved risk stratification in addition to the conventional staging system.
