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

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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.

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Most cited references 20

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Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.

Anna Wagner, Wilfried Grothe, Johannes Haerting … (2006)

This systematic review and meta-analysis were performed to assess the efficacy and tolerability of chemotherapy in patients with advanced gastric cancer. Randomized phase II and III clinical trials on first-line chemotherapy in advanced gastric cancer were identified by electronic searches of Medline, Embase, the Cochrane Controlled Trials Register, and Cancerlit; hand searches of relevant abstract books and reference lists; and contact to experts. Meta-analysis was performed using the fixed-effect model. Overall survival, reported as hazard ratio (HR) with 95% CI, was the primary outcome measure. Analysis of chemotherapy versus best supportive care (HR = 0.39; 95% CI, 0.28 to 0.52) and combination versus single agent, mainly fluorouracil (FU) -based chemotherapy (HR = 0.83; 95% CI = 0.74 to 0.93) showed significant overall survival benefits in favor of chemotherapy and combination chemotherapy, respectively. In addition, comparisons of FU/cisplatin-containing regimens with versus without anthracyclines (HR = 0.77; 95% CI, 0.62 to 0.95) and FU/anthracycline-containing combinations with versus without cisplatin (HR = 0.83; 95% CI, 0.76 to 0.91) both demonstrated a significant survival benefit for the three-drug combination. Comparing irinotecan-containing versus nonirinotecan-containing combinations (mainly FU/cisplatin) resulted in a nonsignificant survival benefit in favor of the irinotecan-containing regimens (HR = 0.88; 95% CI, 0.73 to 1.06), but they have never been compared against a three-drug combination. Best survival results are achieved with three-drug regimens containing FU, an anthracycline, and cisplatin. Among these, regimens including FU as bolus exhibit a higher rate of toxic deaths than regimens using a continuous infusion of FU, such as epirubicin, cisplatin, and continuous-infusion FU.

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Cancer of the stomach. A patient care study by the American College of Surgeons.

R Osteen, H Wanebo, Brett Kennedy … (1993)

The major purpose of this study was to document the modes of presentation, diagnostic methods, clinical management, and outcome of gastric cancer as reported by tumor registries of US hospitals and cancer programs approved by the American College of Surgeons. Gastric cancer continues to diminish in the US, but the stage of disease and survival outcome after surgical resection is unchanged despite increased availability and sophistication of diagnostic techniques. This is in contrast to the marked improvement in survival outcome in Japanese and other Eastern series over the last decades. Possible reasons for the improved Japanese results have been earlier detection secondary to active diagnostic surveillance of the population and widespread adoption of aggressive surgical resection emphasizing wide-field node (R2) dissection. Although selected US centers using the Japanese approach report better survival data, the approach has not been widely adapted by US treatment centers. Tumor registries at American College of Surgeons (ACS) approved hospitals were mailed a study protocol in 1987. They were instructed to review 25 consecutive patients with gastric cancer treated in 1982 (long-term study) and 25 patients treated in 1987 (short-term study). A detailed protocol included significant history, diagnostic results, staging, pathology findings, and treatment results. The data forms on 18,365 patients were returned and analyzed (11,264 patients in the long-term study and 7101 patients in the short-term study). Of 18,365 patients, 63% were males. The median ages were 68.4 years in males and 71.9 years in females. There was a history of gastric ulcer in 25.5% of the patients. Lesion location was upper third in 31%, middle third in 14%, distal third in 26%, and entire stomach in 10% of patients (and the site was unknown in 19%). Gastric resection was performed for 80% of upper third cancers and 85% of distal third cancers; 50% of patients with total gastric involvement had gastric resection. The extent of gastric resection varied according to location. For lower third lesions, subtotal gastrectomy was done in 55% of the cases, extended resection in 21%, and total gastrectomy in 6%. For proximal lesions, 29% had subtotal, 4.6% had total, and 41% had extended gastrectomies (including esophagus), and 13.6% had dissection of celiac nodes. The operative mortality rate was 7.2%. Staging (American Joint Committee on Cancer [AJCC]) was as follows: I, 17%; II, 17%; III, 36%; and IV, 31%. The overall survival rate reflecting deaths from all causes was 14% among 10,891 patients diagnosed in 1982, and it was 19% in patients having resection. The disease specific survival rate was 26%. The survival rate after resection was 19% and 21% for lower and mid third cancers, 10% for upper third cancers, and 4% if the entire stomach was involved. The stage-related survival rates were 50% (stage I), 29% (stage II), 13% (stage III), and 3% (stage IV). Among patients with pathologically clear margins, the survival rate was 35% versus 13% in those with microscopically involved margins, and it was 3% in those with grossly involved margins. This report of gastric cancer treatment by American College of Surgeons approved institutions in the US provides an overview of the disease as commonly treated throughout the US. Although the results are less favorable than those reported by centers with large institutional experiences with this disease and are inferior to those of the Japanese and other Eastern centers, they suggest potential for increasing survival by upstaging through earlier diagnosis and using resectional techniques demonstrated to more adequately control local regional disease.

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Bone metastasis of gastric cancer.

K Yoshikawa,, H. Kitaoka (1983)

Twenty-three patients with bone metastasis from gastric cancer which was resected during the ten years from 1970 through 1979 were investigated. The incidence was 1.2 per cent (23/1,945) and was higher in the younger patients. The main symptom was local bone pain. Change on the X-ray appeared a few months after complaints of pain. Consequently, the confirmation was delayed in most cases. All of the laboratory findings were not specific to bone metastasis. Referring to findings at the primary surgery for gastric cancer, this form of metastasis occurred in cases of a high involvement of regional lymph nodes and of a scirrhous type. The results of histological examination showed a high degree of lymphatic permeation in the submucosal layer. Poorly differentiated adenocarcinoma was readily identified. The lumbar and thoracic vertebra were the areas of frequent metastases. The metastasis occurred within two years after the gastric surgery, in most cases. Chemotherapy was ineffective and radiotherapy was effective for palliation of the bone pain. Prognosis was very poor and all but one patient died within a few months after confirmation of the metastasis.

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Author and article information

Journal

Journal ID (nlm-ta): J Gastric Cancer

Journal ID (iso-abbrev): J Gastric Cancer

Journal ID (publisher-id): JGC

Title: Journal of Gastric Cancer

Publisher: The Korean Gastric Cancer Association

ISSN (Print): 2093-582X

ISSN (Electronic): 2093-5641

Publication date (Print): September 2014

Publication date (Electronic): 30 September 2014

Volume: 14

Issue: 3

Pages: 164-172

Affiliations

Ataturk Chest Disease and Chest Surgery Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.

[1 ]Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey.

[2 ]Ankara Ataturk Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.

[3 ]Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.

Author notes

Correspondence to: Fatma Paksoy Turkoz. Ataturk Chest Disease and Chest Surgery Training and Research Hospital, Department of Medical Oncology, Ataturk Gogus Hastaliklari ve Gogus Cerrahi Egitim ve Arastirma Hastanesi, Medikal Onkoloji Bolumu, Kemoterapi Binasi, 3. Kat, Sanatoryum Caddesi 06280. Kecioren, Ankara. Tel: +90-505-750-95-50, Fax: +90-5057509550, fffpaksoy@ 123456yahoo.com

Article

DOI: 10.5230/jgc.2014.14.3.164

PMC ID: 4199883

PubMed ID: 25328761

SO-VID: 6c0d72c4-a2b0-4a2e-ae1d-113041dcb8d4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 16 June 2014

Date revision received : 25 August 2014

Date accepted : 26 August 2014

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

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Abstract

Purpose

Materials and Methods

Results

Conclusions

Related collections

Karger: Oncology

Most cited references 20

Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.

Cancer of the stomach. A patient care study by the American College of Surgeons.

Bone metastasis of gastric cancer.

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Cited by 40

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