Clinical Characteristics, Prognostic Factors and Therapeutic Strategies in Gastric Cancer Patients With Bone Metastasis: A Retrospective Analysis

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-03-19 DOI:10.1002/cam4.70781

Shiji Ren, Yutao Wei, Wenqi Liu, Yipeng Zhang, Yue Wang, Ju Yang, Baorui Liu, Tao Shi, Jia Wei

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Abstract

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.

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胃癌骨转移的临床特点、预后因素及治疗策略的回顾性分析

背景：骨转移是高度难治性的，生存率极低。尽管骨转移在胃癌（GC）中的发病率越来越高，但对骨转移性胃癌的临床病理特征、预后和治疗的综合分析仍然有限。方法收集南京鼓楼医院120例骨转移性胃癌患者和SEER数据库36139例胃癌患者的资料。卡方检验和Mann-Whitney u检验评估临床病理特征，而Cox模型确定预后因素。Kaplan-Meier曲线和森林图评估了不同治疗策略对骨转移后总生存率（OS-BM）的影响。结果120例骨转移性胃癌患者中，55例（45.83%）诊断为低黏结性胃癌（PCC）。在SEER数据库中，SRCC患者的骨转移发生率也较高（p < 0.0001）。与非PCC患者相比，PCC患者表现出明显的病理特征，包括PD-L1 （p = 0.042）和E-cadherin表达（p = 0.049）降低。多因素分析发现各种不良预后因素，如异时性骨转移（p < 0.001, HR = 2.35, 95% CI: 1.47-3.74）和CA125表达（p = 0.036, HR = 1.60, 95% CI: 1.03-2.48），而免疫治疗是一个阳性预后因素（p < 0.001, HR = 0.44, 95% CI: 0.29-0.66）。亚组分析还显示，接受免疫治疗的不同人群骨转移性胃癌患者的生存率有所提高。此外，包括免疫治疗和其他治疗（抗血管生成治疗和/或局部放疗）在内的联合治疗进一步改善了患者的OS-BM。结论骨转移性胃癌患者具有明显的临床病理特征，PCC骨转移发生率高。以免疫治疗为基础的联合治疗提供了更好的生存益处，因此支持免疫治疗在骨转移高风险的胃癌患者中的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.