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Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis.
The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from Ju...
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... scintigraphy (Fig. 1), PET-CT (Fig. 2), and magnetic resonance imaging (MRI) were used as the methods of diagnos- ing bone metastasis. All the patients with bone metastasis were classified according to Borrmann's morphology as assessed by the gastroscopic findings, the location of the gastric cancer and the histological types, and their correlations with ...Citations
... Bone is a common metastatic site for various solid tumors, and the incidence of bone metastasis is rising in gastrointestinal cancers, including GC [2][3][4][5]. Bone metastasis presents significant challenges due to its asymptomatic onset, lack of early diagnostic markers, and poorly defined prognostic factors, making effective management difficult [6][7][8]. Thus, it is necessary to further explore the clinicopathological characteristics and treatments for GC patients with bone metastasis. ...
... Bone metastasis remains an incurable form of cancer with extremely poor prognosis and increasing incidence in GC [2,7,8]. However, the comprehensive analysis of clinicopathological characteristics, prognostic factors, and treatment strategies for bone-metastatic GC patients is still inadequate. ...
Background
Bone metastases are highly refractory and are associated with extremely poor survival. Despite the increasing incidence of bone metastasis in gastric cancer (GC), comprehensive analyses regarding the clinicopathological features, prognosis, and treatment of bone‐metastatic GC remain limited.
Methods
We obtained data from 120 bone‐metastatic GC patients from Nanjing Drum Tower Hospital and 36,139 GC patients from the SEER database. Chi‐square and Mann–Whitney U‐tests evaluated clinicopathological features, while Cox models identified prognostic factors. Kaplan–Meier curves and forest plots assessed the effects of different treatment strategies on overall survival after bone metastasis (OS‐BM).
Results
Among 120 bone‐metastatic GC patients, 55 (45.83%) were diagnosed with poorly cohesive gastric carcinoma (PCC). The higher incidence of bone metastasis was also observed in SRCC patients from the SEER database (p < 0.0001). PCC patients exhibited distinct pathological features compared to non‐PCC patients, including lower PD‐L1 (p = 0.042) and E‐cadherin expression (p = 0.049). Multivariate analysis identified various negative prognostic factors such as metachronous bone metastasis (p < 0.001, HR = 2.35, 95% CI:1.47–3.74) and CA125 expression (p = 0.036, HR = 1.60, 95% CI:1.03–2.48), whereas immunotherapy was a positive prognostic factor (p < 0.001, HR = 0.44, 95% CI:0.29–0.66). Subgroup analysis also showed improved survival among different populations of bone‐metastatic GC patients receiving immunotherapy. Moreover, combinational therapies including immunotherapy and other treatments (anti‐angiogenic therapy and/or local radiotherapy) further improved patient OS‐BM.
Conclusion
Our results suggest bone‐metastatic GC patients exhibit distinct clinicopathological features, with a high incidence of bone metastasis in PCC. Immunotherapy‐based combination therapies offer improved survival benefits, thus supporting the application of immunotherapy in GC patients at high risk of bone metastasis.
... Typically, BM in GC tend to occur in younger individuals and show an association with histologically undifferentiated adenocarcinoma, particularly signet-ring cell carcinoma. Additionally, it is associated with high angioinvasiveness and with advanced-stage disease accompanied by lymph node metastasis (19). In three of our cases, the histological subtype of GC was diffuse, consistent with literature findings (19). ...
... Additionally, it is associated with high angioinvasiveness and with advanced-stage disease accompanied by lymph node metastasis (19). In three of our cases, the histological subtype of GC was diffuse, consistent with literature findings (19). It is exceptionally rare for the primary tumor type to be intestinal, as in one of our patients, with no reported cases in the literature to our knowledge. ...
Background
Gastric cancer (GC) is the fifth most common cancer globally and the third leading cause of cancer-related deaths. While it predominantly metastasizes to the liver, peritoneum, and lungs, bone metastasis (BM) is a rare but severe complication. BM occurs in 1–20% of GC cases and is associated with a poor prognosis. Typically, BM in GC presents at advanced stages, often with non-specific symptoms, making early detection challenging.
Case Description
This retrospective study analyzed 118 GC patients treated at our institution from 2010 to 2020. Among them, eight patients (6.8%) developed BM, with an equal split between osteoblastic and osteolytic types. Osteoblastic BM was observed exclusively in men, with a mean age of 72.25 years. The median time from GC diagnosis to BM onset was 27.5 months. BM was primarily detected through periodic thoracoabdominal CT scans, and bone scintigraphy confirmed the osteoblastic nature of the lesions. All patients had advanced GC and were under palliative care at the time of BM diagnosis. The average survival time from BM diagnosis was 8.5 months.
Conclusions
BM in GC patients is rare but significantly worsens the prognosis. The findings suggest that osteoblastic BM may be more common in GC than previously reported, potentially due to improved imaging techniques and extended patient survival. This study underscores the importance of vigilant radiological monitoring in GC patients, particularly those with non-specific symptoms suggestive of BM. Enhanced collaboration between oncology and palliative care teams is essential to manage symptoms effectively and improve patient quality of life. Future research should focus on the incidence and management of BM in GC, particularly the role of targeted therapies in improving patient quality of life.
Keywords
Bone metastasis (BM); gastric cancer (GC); osteoblastic; disease progression; case report
... In a series examining the frequency of BMM in patients with gastric carcinoma, the incidence of BMM was found to be 1% [5]. In a study examining 2150 patients with metastatic gastric carcinoma, the frequency of BMM was reported to be only 0.9% [6]. The most useful imaging modality for detecting BMMs is PET/CT, and in our patient, widespread increased metabolic activity was detected in bone using PET/ CT [7]. ...
... The percentage of metastasis of gastric cancer that spreads to the bones corresponds to 3.8%, according to the Journal of Gastric Cancer [3]. Patients who have bone metastasis have, unfortunately, a poorer prognosis, with a median survival period of approximately three to four months [4]. Unfortunately, gastric cancer has been identified as the third-leading cause of cancer-related deaths [5]. ...
Gastric cancers rarely metastasize to the bones. If they do, they have a very poor prognosis. We here present a case study of a 56-year-old man who, within a year, rapidly declined and died. He was first revealed to have an erosion found on an esophageal gastroduodenoscopy (EGD), which was later proven to be a poorly differentiated gastric adenocarcinoma. He then proceeded to have a thoracic trans-hiatal esophagogastrostomy with gastric pull-up to resect this cancer. At this point in time, the review of systems and CT scans of the abdomen and pelvis were negative. A few months later, he started having back pain and was diagnosed with metastatic disease of the bones through a CT scan. Although detecting gastric cancer at an early stage is rare, it is shown to have a better prognosis. It is, therefore, very important to reflect on the possibility of engaging in earlier screening to detect gastric cancers at an earlier stage to minimize the risk of invasions of other organs, especially for those who have other risk factors such as obesity and tobacco use. We believe it is prudent to ensure close follow-up with any patient with early gastric cancer to potentially detect recurrence or metastasis in a timely fashion.
... with poor prognosis [7,8]. The median survival time of patients with gastric cancer and bone metastasis is 3-4 months after the detection of bone metastasis [9]. Consequently, metastatic gastric cancer, particularly in patients with advanced bone marrow metastases, remains a significant therapeutic challenge for medical oncologists because of its association with advanced disease progression [10]. ...
We investigated whether radiomics of computed tomography (CT) image data enables the differentiation of bone metastases not visible on CT from unaffected bone, using pathologically confirmed bone metastasis as the reference standard, in patients with gastric cancer. In this retrospective study, 96 patients (mean age, 58.4 ± 13.3 years; range, 28–85 years) with pathologically confirmed bone metastasis in iliac bones were included. The dataset was categorized into three feature sets: (1) mean and standard deviation values of attenuation in the region of interest (ROI), (2) radiomic features extracted from the same ROI, and (3) combined features of (1) and (2). Five machine learning models were developed and evaluated using these feature sets, and their predictive performance was assessed. The predictive performance of the best-performing model in the test set (based on the area under the curve [AUC] value) was validated in the external validation group. A Random Forest classifier applied to the combined radiomics and attenuation dataset achieved the highest performance in predicting bone marrow metastasis in patients with gastric cancer (AUC, 0.96), outperforming models using only radiomics or attenuation datasets. Even in the pathology-positive CT-negative group, the model demonstrated the best performance (AUC, 0.93). The model’s performance was validated both internally and with an external validation cohort, consistently demonstrating excellent predictive accuracy. Radiomic features derived from CT images can serve as effective imaging biomarkers for predicting bone marrow metastasis in patients with gastric cancer. These findings indicate promising potential for their clinical utility in diagnosing and predicting bone marrow metastasis through routine evaluation of abdominopelvic CT images during follow-up.
... In a series examining the frequency of bone marrow metastasis in gastric carcinoma patients, the incidence of bone marrow metastasis was found to be below 1% [5]. In a study examining 2150 patients with metastatic gastric carcinoma, the frequency of bone marrow metastasis was reported to be only 0.9% [6]. The most useful imaging method for detecting bone marrow metastases is PET/CT, and in our patient, widespread increased metabolic activity was detected in bones with PET/CT [7]. ...
Gastric carcinoma is one of the most common types of cancer worldwide. While intra-abdominal metastasis is common, bone marrow metastasis is quite rare, and these patients may present with cytopenia. We present the case of a patient with gastric carcinoma and bone marrow metastasis, whose bone marrow suppression, bicytopenia (anemia and thrombocytopenia) regressed after two cycles of chemotherapy. A 58-year-old male patient with advanced-stage gastric adenocarcinoma presented with bicytopenia. Bone marrow metastasis was confirmed by bone marrow aspiration biopsy. Bone marrow suppression regressed after initiation of chemotherapy. Bone marrow metastases are rare in gastric carcinoma, and there is no standard treatment for these patients. Our case report is remarkable as it demonstrates a rare instance of bone marrow suppression responding to chemotherapy in these patients, and suggests the potential effectiveness of 5-FU and platinum-based chemotherapies. ÖZET Mide kanseri dünya çapında en sık görülen kanser türlerinden biridir. İntraabdominal metastazlar sık olmakla birlikte kemik iliği metastazı oldukça nadirdir ve bu hastalar sitopeni ile başvurabilmektedir. Bİz kemik iliği metastazı olan, iki kür kemoterapiyle kemik iliği supresyonu, bisitopenisi (anemi ve trombositopeni) gerileyen bir mide karsinomu hastasını sunmaktayız. Metastatik mide adenokarsinomlu 58 yaşında erkek hasta bisitopeni ile başvurdu. Kemik iliği aspirasyon biyopsisi ile kemik iliği metastazı doğrulandı. Kemoterapi başlandıktan sonra kemik iliği baskılanmasının gerilediği görüldü. Mide karsinomunda kemik iliği metastazları nadirdir ve bu hastalarda standart bir tedavi yöntemi yoktur. Olgu sunumumuz bu hastalarda kemoterapiye kemik iliği baskılanması yanıtının nadir bir örneği olması ve bu hastalarda 5-FU ve platin bazlı kemoterapilerin potansiyel etkinliğini göstermesi açısından dikkat çekicidir.
... He survived only five weeks from the first complementary diagnostic test showing bone lesions and about three and a half weeks after the gastric lesion biopsy, it not being perfectly clear if the death was either due to the progression of the metastatic tumor or to the stroke consequences (itself a probable complication associated with the neoplasia), but most likely to a combination of both. In fact, in the published literature, some studies reported a median survival time, after detection of bone involvement, of 4 to 6 months [3,[6][7][8][9]. ...
Bone metastasis might be associated with several tumors; however, the association between gastric malignant neoplasms and bone secondary lesions is very rare, with the osteoblastic form having the rarest presentation. In fact, osteoblastic lesions, as the first presentation of gastric adenocarcinomas, are even rarer and known to have a very poor prognosis associated with them.
Therefore, we present a clinical case of a patient with lower back pain as the first symptom, which led to the diagnosis of osteoblastic lesions of the spine and iliac bones, suggested as secondary lesions. Later, the investigation of the primary tumor led to the diagnosis of a gastric adenocarcinoma (stage IV disease).
In this report, we highlight the steps taken for the etiological study course and the challenges associated with them from the beginning. We also emphasize the very unfavorable evolution of our patient, with the inability to carry out targeted treatment, neither curative nor palliative, due to the advanced stage of the disease and the very poor survival time associated with it.
... GC patients with BM often experience a poor prognosis and shortened survival time, as cancer cells have spread to the bone and are often accompanied by metastasis to other organs (8). This can lead to bone pain, significantly affecting the patient's quality of life (9,10). ...
... Our study found that the independent risk factors for the development of BM in GC were age, primary site, grade III, T stage, N stage, and brain, liver, and lung metastasis, but especially brain metastasis. Many previous studies have found that the primary gastric cancer lesions were located in the gastric antrum and body; in addition, patients with poorly differentiated tumors, deep local invasion, and lymph node metastasis are more likely to develop bone metastases (7,8,21). Qiu et al. (9) showed that compared with GC patients without distant metastasis, patients with distant metastasis were more likely to have BM. ...
Purpose
Our aim was to identify the clinical characteristics and develop and validate diagnostic and prognostic web-based dynamic prediction models for gastric cancer (GC) with bone metastasis (BM) using the SEER database.
Method
Our study retrospectively analyzed and extracted the clinical data of patients aged 18-85 years who were diagnosed with gastric cancer between 2010 and 2015 in the SEER database. We randomly divided all patients into a training set and a validation set according to the ratio of 7 to 3. Independent factors were identified using logistic regression and Cox regression analyses. Furthermore, we developed and validated two web-based clinical prediction models. We evaluated the prediction models using the C-index, ROC, calibration curve, and DCA.
Result
A total of 23,156 patients with gastric cancer were included in this study, of whom 975 developed bone metastases. Age, site, grade, T stage, N stage, brain metastasis, liver metastasis, and lung metastasis were identified as independent risk factors for the development of BM in GC patients. T stage, surgery, and chemotherapy were identified as independent prognostic factors for GC with BM. The AUCs of the diagnostic nomogram were 0.79 and 0.81 in the training and test sets, respectively. The AUCs of the prognostic nomogram at 6, 9, and 12 months were 0.93, 0.86, 0.78, and 0.65, 0.69, 0.70 in the training and test sets, respectively. The calibration curve and DCA showed good performance of the nomogram.
Conclusions
We established two web-based dynamic prediction models in our study. It could be used to predict the risk score and overall survival time of developing bone metastasis in patients with gastric cancer. In addition, we also hope that these two web-based applications will help physicians comprehensively manage gastric cancer patients with bone metastases.
... Gastric cancer rarely metastases to bone, and when GC-BM happens to patients, they may have no obvious symptoms, or bone pain is the only symptom. Retrospective analyses of different gastric cancer populations and the statistics of case studies show that the incidence of bone metastasis in GC patients is roughly in the range of 0.9-13.4% [5,6,8,10,71]. GC-BM can develop in cancers regardless of the tumor stage; however, it is more prevalent in advanced-stage disease. ...
Gastric cancer (GC) is one of the most malignant neoplasms worldwide, accounting for about 770,000 deaths in 2020. The incidence of gastric cancer bone metastasis (GC-BM) is low, about 0.9–13.4%, and GC patients develop GC-BM because of a suitable bone microenvironment. Osteoblasts, osteoclasts, and tumor cells interact with each other, secreting cytokines such as PTHrP, RANK-L, IL-6, and other growth factors that disrupt the normal bone balance and promote tumor growth. The functions and numbers of immune cells in the bone microenvironment are continuously inhibited, resulting in bone balance disorder due to the cytokines released from destroyed bone and growing tumor cells. Patients with GC-BM are generally younger than 65 years old and they often present with a later stage of the disease, as well as more aggressive tumors. They usually have shorter overall survival (OS) because of the occurrence of skeletal-related events (SREs) and undetected bone destruction due to the untimely bone inspection. Current treatments of GC-BM focus mainly on gastric cancer and SRE-related treatment. This article reviews the clinical features, possible molecular pathogeneses, and the most commonly used diagnostic methods and treatments of bone metastasis in gastric cancer.
... Bone involvement is more probable in superficially depressed, ulcerated, large, or corpus carcinomas and is more often associated with the presence of lymph node metastasis and elevated CEA levels [13]. The most likely etiologies may be poorly differentiated signet ring cells and high-grade and mucinous carcinomas [8,[13][14][15]. Although infrequent, this pattern of GC metastasization might be observed in younger patients and is associated with a worse prognosis [8]. ...
... However, these markers are not always abnormally elevated and further tests are generally required [5,8,20]. The diagnosis may be established by imaging methods, such as CT, magnetic resonance, bone scintigraphy, and positron emission tomography, and by biopsy [8,15,16,18]. Often, the pain has a marked impact on a patient's quality of life and is usually managed with opioids [11], surgery, or radiotherapy [8,20]. Chemotherapy may be offered for GC patients with bone or bone marrow metastases, however, due to the possible co-existence of cytopenia and deterioration of the patient's performance status, it may be challenging and a standard regimen has not been established [5,8,11,16]. ...
Gastric cancer (GC) is a worldwide health condition of major concern, with gastric carcinoma with signet ring cell features being increasingly reported. A 61-year-old woman was admitted to the Emergency department with back pain, gastrointestinal complaints, and weight loss. A lumbar and hip computed tomography (CT) was performed and revealed multiple suspicious secondary bone lesions. Laboratory test results reported anemia, thrombocytopenia, and elevated alkaline phosphatase. On thoracic-abdominal-pelvic CT, multiple bone lesions suggestive of metastases were visible on the vertebral spine, ribs, pelvic bones, and proximal femurs, but no identifiable primary or visceral lesions were described. Upper endoscopy identified a gastric adenocarcinoma, and both gastric and bone lesions, especially bone lesions, contained a relevant amount of signet ring cells. The patient was referred to the Medical Oncology department, however, her condition evolved unfavorably. GC with restricted bone metastasis is rare at presentation and has a poor prognosis. Despite its infrequency, clinicians should consider GC involvement when evaluating secondary suspicious bone lesions.
