J Gastric Cancer.  2014 Sep;14(3):164-172. 10.5230/jgc.2014.14.3.164.

Bone Metastasis from Gastric Cancer: The Incidence, Clinicopathological Features, and Influence on Survival

• Turkoz FP
• Solak M
• Kilickap S
• Ulas A
• Esbah O
• Oksuzoglu
• Yalcin S

• KMID: 2372527
• DOI: http://doi.org/10.5230/jgc.2014.14.3.164

Abstract

PURPOSE
To evaluate the incidence, clinicopathological characteristics, treatment outcomes, prognostic factors, and survival of gastric cancer patients with bone metastases.
MATERIALS AND METHODS
Of 4,617 gastric cancer patients who were treated between 2001 and 2013, 176 patients with bone metastases were analyzed.
RESULTS
The incidence of bone metastasis was 3.8%. The most common histopathological subtype was adenocarcinoma (79%) with poor differentiation (60.8%). The median interval from the diagnosis to bone metastasis was 11 months. The median survival time after bone metastasis was 5.4 months. Factors that were associated with longer median survival times included the following: isolated bone metastasis (P=0.004), well-differentiated tumors (P=0.002), palliative chemotherapy (P=0.003), zoledronic acid treatment (P<0.001), no smoking history (P=0.007), and no metastatic gastric cancer at the time of diagnosis (P=0.01). On the other hand, high levels of lactate dehydrogenase (LDH) (hazard ratio [HR]: 1.86; P=0.015), carcinoembryonic antigen (CEA) (HR: 2.04; P=0.002), and carbohydrate antigen (CA) 19-9 (HR: 2.94; P<0.001) were associated with shorter survival times. In multivariate analysis, receiving zoledronic acid (P<0.001) and performance status (P=0.013) were independent prognostic factors.
CONCLUSIONS
Smoking history, poor performance status, poorly differentiated adenocarcinoma, and high levels of LDH, CEA, and CA 19-9 were shown to be poor prognostic factors, while receiving chemotherapy and zoledronic acid were associated with prolonged survival in gastric cancer patients with bone metastases.

Keyword

Stomach neoplasms; Bone metastasis; Prognosis; Survival; Zoledronic acid

MeSH Terms

Adenocarcinoma
Carcinoembryonic Antigen
Diagnosis
Drug Therapy
Hand
Humans
Incidence*
L-Lactate Dehydrogenase
Multivariate Analysis
Neoplasm Metastasis*
Prognosis
Smoke
Smoking
Stomach Neoplasms*
Carcinoembryonic Antigen
L-Lactate Dehydrogenase
Smoke

Figure

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  Fig. 1 Overall survival of patients after developing bone metastasis. OS-BM = overall survival after developing bone metastasis.

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  Fig. 2 Overall survival of patients with and without isolated bone metastasis. OS-BM = overall survival after developing bone metastasis.

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  Fig. 3 Overall survival of patients after developing bone metastasis, according to the performance status. OS-BM = overall survival after developing bone metastasis, ECOG = Eastern Cooperative Oncology Group scale.

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  Fig. 4 Overall survival of patients receiving chemotherapy after developing bone metastasis. OS-BM = overall survival after developing bone metastasis.

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  Fig. 5 Overall survival of patients receiving zoledronic acid after developing bone metastasis. OS-BM = overall survival after developing bone metastasis.

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  Fig. 6 Overall survival of patients receiving zoledronic acid after developing bone metastasis, according to the TNM stage. OS-BM = overall survival after developing bone metastasis.

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