Clinical pattern and outcome of gastric cancer patients with skeletal metastases

Abstract

[한글]

[영문]BACKGROUND: Skeletal metastasis is an adverse prognostic factor in gastriccancer, with a rapidly deteriorating clinical course and quality of life. However,current data provide only limited information about it. Herein we evaluated theclinical manifestations and prognostic factors, and treatment outcomes ofgastric cancer patients with skeletal metastasis at diagnosis or during treatment.METHODS: We retrospectively reviewed the patients treated between January1998 and May 2008 in Yonsei University Health System. Radiographs ofspecific bones were taken to diagnose skeletal metastases after an abnormalbone scan or because of clinical symptoms such as pain or paralysis.Radiologists who had no knowledge of the results of any other radiologic orbiochemical examinations interpreted the radiographs.RESULTS: We identified skeletal metastasis in 203 (2.4%) of 8,633 patients;126 patients (62%) had skeletal metastasis at diagnosis (synchronous), andremaining 77 patients developed metastasis during follow-up (metachronous).The median time to skeletal metastasis was 16 months (range, 4 to 87 months).Most patients (n=180, 89%) demonstrated metastasis involving multiple bonesand the spine (86%) was most frequent site. Six patients (3%) developedskeletal metastasis-related events (SRE): Three suffered pathologic fractures,one developed paralysis, and two developed hypercalcemia.As for treatment, 120 patients (59%) received chemotherapy, with or withoutradiotherapy, and remaining 83 received local (radio)therapy or supportive careonly. The median survival time after skeletal metastasis was 103 days (95% CI,80-126 days).Multivariate analysis revealed that elevated ALP [> 158 IU/L; Relative risk(RR)=2.00, p<0.001] and poor performance status [ECOG 3-4; RR=2.11,p=0.003] implied a poor prognosis. For patients who had none or only one ofthese adverse factors identified, chemotherapy had a beneficial effect(p<0.0001).CONCLUSION: This is the first study to investigate the factors that predictsurvival in gastric cancer patients with skeletal metastasis. We recommend thattherapy for gastric cancer with skeletal metastasis be tailored to the adversefactors of each patient in order to extend survival and improve the quality of life