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

Abstract

BackgroundWhile bone metastasis is not common in gastric adenocarcinoma (GaC), it can have important impacts on prognosis. This large cohort study aimed at exploring factors associated with bone metastasis in GaC and investigating the time-dependent cumulative mortalities and prognostic factors in GaC patients with bone metastasis at the population level.MethodsData on patients with GaC diagnosed in 2010–2016 were retrieved from a large population-based database. We explored factors associated with bone metastasis using the multivariable-adjusted logistic model. We then calculated the time-dependent cancer-specific mortalities in GaC patients with bone metastasis using the cumulative incidence function and compared mortalities across subgroups using Gray’s test. We further assessed factors associated with mortality using the multivariable-adjusted Fine–Gray subdistribution hazard model.ResultsTogether 11,072 eligible patients with metastatic GaC were enrolled, which comprised 1,511 (14%) people with bone metastasis and 9,561 (86%) with other metastasis, encompassing 6,999 person-years of follow-up. Bone metastasis was more frequently detected in 2014 or later, in younger patients, in patients with gastric cardia cancers, in people with signet-ring cell carcinoma, and in those with poorly differentiated/undifferentiated cancers; it was less commonly observed in black patients. Bone metastasis was associated with more frequent brain and lung metastases. The median survival of patients with bone metastasis was 4 months; the 6-month and 3-year cancer-specific cumulative mortalities were 56% and 85%, respectively. In patients receiving chemotherapy, American Indians/Alaskan Natives, patients with gastric antrum/pylorus cancers, and those with positive lymph nodes had higher mortality risks, while those undergoing resection had lower mortality hazards.ConclusionIn GaC patients, bone metastasis was associated with various clinicopathologic factors including age, ethnicity, tumor location, histology, differentiation, and metastasis to other sites. Patients with bone metastasis had poor prognosis which was associated with ethnicity, tumor location, lymph node involvement, and treatment. Our findings provide important hints for tailed patient management and for further mechanistic investigations.

Genomic alterations of cerebrospinal fluid cell-free DNA in leptomeningeal metastases of gastric cancer

“…Adenocarcinoma is the major form of LM, and breast, lung, and skin are the most common primary sites of tumorigenesis [ 1 ]. In contrast, LM is relatively rare in gastric cancer (GC), with a frequency of only 0.16–0.69% [ 2 – 5 ]. Despite recent advances in systemic chemotherapy, the prognosis of gastric cancer patients with LM remained poor, with a median survival time of 4–6 weeks [ 6 ].…”

Continuous care needs in patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai: A qualitative study

“…Cancer patients undergoing chemotherapy experience a long-term treatment process ( Huang et al, 2014 , 2018b , 2019a ; Cha et al, 2021 ), especially during the COVID-19 outbreak. Addressing patients’ needs, including disease management needs, medical needs, and spiritual needs, will affect their and their caregivers’ quality of life and life satisfaction ( Wei et al, 2020 ; Huang et al, 2020c , d , 2021d , e , 2022b , d ; Guo et al, 2021 ). To meet these challenges, medical staff should conduct related health education for patients while they are still in the hospital, provide efficient and convenient continuous nursing measures, and strengthen caregivers’ initiative to ensure that patients actively participate in their treatment process and improvement of their quality of life.…”

Editorial: The use of chemotherapy in treating gastric cancers

“…For metastatic GC, chemotherapy may be the most important treatment modality, and innovative regimens with both good efficacy and safety profiles are desperately needed to enhance prognosis (8). Feldbrügge et al for the first time retrospectively evaluated the safety of systemic chemotherapy (with or without the VEGFR2 antagonist ramucirumab) combined with pressurized intraperitoneal aerosol chemotherapy (PIPAC), a local chemotherapy method using the laparoscopic technique, for GC with peritoneal metastasis.…”

“…In 2020, over 1,089,000 new cases of GC and approximately 769,000 GC-associated new deaths were estimated worldwide ( 1 – 4 ). A noticeable proportion of GC cases are diagnosed at later stages, which can rule out resection as a primary treatment option, leaving systemic options which commonly involve chemotherapy, either as monotherapy or combined with other therapies ( 5 – 8 ). Chemotherapy is also frequently utilized in the adjuvant and/or neoadjuvant setting for cases manageable with resection ( 9 – 11 ).…”

“…For metastatic GC, chemotherapy may be the most important treatment modality, and innovative regimens with both good efficacy and safety profiles are desperately needed to enhance prognosis ( 8 ). Feldbrügge et al .…”