Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them

Abstract

Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported in the literature. Nevertheless, it is unclear how the metastatic sites may affect the prognosis. In particular, knowledge about the impact of bone metastases on GC patients’ outcome is scant, and this may be related to the rarity of bone lesions and/or their underestimation at the time of diagnosis. In fact, there is still a lack of specific recommendation for their detection at the diagnosis. Then, the majority of the evidences in this field came from retrospective analysis on very heterogeneous study populations. In this context, the aim of this narrative review is to delineate an overview about the evidences existing about bone metastases in GC patients, focusing on their incidence and biology, the prognostic role of bone involvement, and their possible implication in the treatment choice.

Gastric Cancer With Multiple Bone Metastases: An Uncommon Primary Presentation

“…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].…”

“…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]. The case we present was a patient with a primary gastric mixed adenocarcinoma with tubular areas and poorly cohesive cells, including signet ring cells, which presented uncommon mixed and synchronous exuberant bone metastases, of the signet ring cell component, in several skeletal segments.…”

“…GC metastases are typically found in the liver, peritoneum, and lymph nodules and less frequently in the ovaries, lungs, central nervous system, spleen, adrenal glands, and bone [ 5 , 6 ]. GC less frequently invades the bone (0.9-13.4%) [ 8 ] or the bone marrow (0.024%) [ 7 ], and this state is usually described as the disease progresses and less as the primary presentation [ 9 , 10 ]. Moreover, in one of the largest multicentric works in which GC bone metastasis onset was detailed, only 28% presented these lesions at the time of diagnosis [ 10 ].…”

Bone Metastasis From Gastric Adenocarcinoma—What Are the Risk Factors and Associated Survival? A Large Comprehensive Population-Based Cohort Study

“…There have been few reports on the factors associated with bone metastasis and its prognostic impact among patients with GaC, which may be due to the rarity and/or underestimation at diagnosis (11,12).…”

Multimodality Treatment in Metastatic Gastric Cancer: Working Together to Tailor the Continuum of Care

“…In the field of metastatic GC today, it is still unclear how the metastatic sites may affect the prognosis and little evidence exists regarding the impact of rare metastatic locations (e.g., lung, bone and brain). Therefore, a narrative review regarding the role of bone metastases in GC and their potential implication in treatment choice was also included in this Special Issue [ 6 ].…”