Bone metastasis in colorectal cancer: Pathophysiology, prognostic factors, survival outcomes, and treatment strategies – A comprehensive review

IF 3.6 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-12-01 Epub Date: 2025-11-12 DOI:10.1016/j.jbo.2025.100727

Lea Hatoum , Rita El Murr , Ahmad Assi , Rami Mohanna , Amer Sebaaly , Hampig-Raphaël Kourie

{"title":"Bone metastasis in colorectal cancer: Pathophysiology, prognostic factors, survival outcomes, and treatment strategies – A comprehensive review","authors":"Lea Hatoum , Rita El Murr , Ahmad Assi , Rami Mohanna , Amer Sebaaly , Hampig-Raphaël Kourie","doi":"10.1016/j.jbo.2025.100727","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer ranks as the third most prevalent cancer globally, with over 1.9 million new cases and 930,000 deaths in 2020. While the liver and lungs are the most common site of colorectal cancer metastases, bone metastasis is relatively rare but clinically significant. The rarity of bone metastasis in colorectal cancer, early diagnosis challenges, and the poorly understood mechanisms underlying bone metastasis have resulted in lesser research compared to other metastatic sites of colorectal cancer.</div></div><div><h3>Objective</h3><div>The goal of this review is to summarize pathophysiology, clinical presentation, risk and prognostic factors, survival outcomes, and treatment options for bone metastasis in colorectal cancer. Results: Bone metastasis occurred in 6 to 10 % of colorectal cancer patients, with the spine and pelvis being the most common sites. Bone metastasis from colorectal cancer may result from hematogenous dissemination and retrograde venous flow through Batson’s plexus. Early diagnosis can be challenging, and Positron Emission Tomography / Computed Tomography (PET/CT) provided the best accuracy for diagnosing bone metastasis in colorectal cancer. Isolated bone metastasis, low neutrophil-to-lymphocyte ratio (NLR) (high NLR with HR: 1.54), low alkaline phosphatase levels, N0 stage colorectal cancer were associated with a better prognosis and survival. High carcinoembryonic antigen (OR: 2.368, HR: 3.300), alkaline phosphatase (OR: 6.89, HR: 2.12), and CA 19–9 levels (HR: 1.5), Lactate dehydrogenase (HR: 1.961), perineural invasion (HR: 3.457), right sided location (HR: 1.84), multiples bone metastasis sites (HR: 1.452), hypercalcemia (HR: 3.75), pathologic fracture (HR:1.91) and more than two extra-bone metastatic organs (HR: 2.357) were linked to worse prognosis. The therapeutic approach for colorectal cancer patients with bone metastasis consists of a multidisciplinary strategy including systemic chemotherapy, palliative surgery, radiotherapy and bisphosphonate.</div></div><div><h3>Conclusion</h3><div>Early diagnosis and management of bone metastasis in colorectal cancer patients is essential to improve quality of life and survival. Further research is needed to identify methods for early detection and develop tailored treatment strategies.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"55 ","pages":"Article 100727"},"PeriodicalIF":3.6000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212137425000685","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/11/12 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Colorectal cancer ranks as the third most prevalent cancer globally, with over 1.9 million new cases and 930,000 deaths in 2020. While the liver and lungs are the most common site of colorectal cancer metastases, bone metastasis is relatively rare but clinically significant. The rarity of bone metastasis in colorectal cancer, early diagnosis challenges, and the poorly understood mechanisms underlying bone metastasis have resulted in lesser research compared to other metastatic sites of colorectal cancer.

Objective

The goal of this review is to summarize pathophysiology, clinical presentation, risk and prognostic factors, survival outcomes, and treatment options for bone metastasis in colorectal cancer. Results: Bone metastasis occurred in 6 to 10 % of colorectal cancer patients, with the spine and pelvis being the most common sites. Bone metastasis from colorectal cancer may result from hematogenous dissemination and retrograde venous flow through Batson’s plexus. Early diagnosis can be challenging, and Positron Emission Tomography / Computed Tomography (PET/CT) provided the best accuracy for diagnosing bone metastasis in colorectal cancer. Isolated bone metastasis, low neutrophil-to-lymphocyte ratio (NLR) (high NLR with HR: 1.54), low alkaline phosphatase levels, N0 stage colorectal cancer were associated with a better prognosis and survival. High carcinoembryonic antigen (OR: 2.368, HR: 3.300), alkaline phosphatase (OR: 6.89, HR: 2.12), and CA 19–9 levels (HR: 1.5), Lactate dehydrogenase (HR: 1.961), perineural invasion (HR: 3.457), right sided location (HR: 1.84), multiples bone metastasis sites (HR: 1.452), hypercalcemia (HR: 3.75), pathologic fracture (HR:1.91) and more than two extra-bone metastatic organs (HR: 2.357) were linked to worse prognosis. The therapeutic approach for colorectal cancer patients with bone metastasis consists of a multidisciplinary strategy including systemic chemotherapy, palliative surgery, radiotherapy and bisphosphonate.

Conclusion

Early diagnosis and management of bone metastasis in colorectal cancer patients is essential to improve quality of life and survival. Further research is needed to identify methods for early detection and develop tailored treatment strategies.

Abstract Image

查看原文本刊更多论文

结直肠癌骨转移：病理生理学，预后因素，生存结果和治疗策略-全面回顾

结直肠癌是全球第三大流行癌症，2020年将有190多万新病例和93万例死亡。虽然肝和肺是结直肠癌最常见的转移部位，但骨转移相对罕见，但具有临床意义。与结直肠癌的其他转移部位相比，结直肠癌骨转移的罕见性、早期诊断的挑战以及对骨转移机制的不了解导致对骨转移的研究较少。目的总结结直肠癌骨转移的病理生理、临床表现、风险和预后因素、生存结局和治疗方案。结果：结直肠癌患者骨转移发生率为6 ~ 10%，以脊柱和骨盆为最常见部位。结直肠癌的骨转移可能是由血液播散和通过巴氏神经丛的逆行静脉流动引起的。早期诊断具有挑战性，正电子发射断层扫描/计算机断层扫描（PET/CT）为诊断结直肠癌骨转移提供了最好的准确性。分离性骨转移、低中性粒细胞与淋巴细胞比值（NLR高，HR为1.54）、低碱性磷酸酶水平、N0期结直肠癌与较好的预后和生存相关。高癌胚抗原（OR: 2.368, HR: 3.300）、碱性磷酸酶（OR: 6.89, HR: 2.12）和CA 19-9水平（HR: 1.5）、乳酸脱氢酶（HR: 1.961）、神经周围浸润（HR: 3.457）、右侧位置（HR: 1.84）、多个骨转移部位（HR: 1.452）、高钙血症（HR: 3.75）、病理性骨折（HR:1.91）和两个以上骨外转移器官（HR: 2.357）与预后不良有关。结直肠癌骨转移患者的治疗方法由多学科策略组成，包括全身化疗、姑息性手术、放疗和双磷酸盐。结论结直肠癌骨转移的早期诊断和处理是提高患者生活质量和生存率的关键。需要进一步的研究来确定早期发现的方法并制定量身定制的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.