Overt bone metastasis and bone marrow micrometastasis of early gastric cancer

Abstract

Recently we encountered two cases of early gastric cancer (EGC) with bone metastasis after surgery. As they were not accompanied by overt liver, lung, or peritoneal metastasis, we examined the clinical significance of bone metastasis in EGC and its mechanisms by a review of the literature. We found only 10 cases of EGC complicated with overt bone metastasis in the English literature, so we also examined the Japanese reports of such cases. The main histologic type of cases of bone metastasis from EGC was the diffuse type, and there were long intervals between surgery and overt bone metastasis. One reason for such long intervals may have been the tumor dormancy. Two types of dormancy, dynamic and static, and two types of postoperative overt metastases, that of micrometastatic origin (normograde metastatic process) and that of bone marrow origin (retrograde metastatic process), were considered. We speculated that there may be specific routes by which the cancer cells infiltrate the bone marrow directly from EGC or lymph node metastasis. The procedures for diagnosing bone micrometastasis using monoclonal antibodies have recently been improved, but their accuracy rates are still not universally accepted. New, more reliable examinations are required to improve the survival rates of EGC.

Bone recurrence after curative resection of gastric cancer

“…The mean tumor size was 3.9 ± 2.7 cm (range 0. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The median follow-up period was 56 months.…”

“…That study showed a wide variety of surveillance approaches, and also revealed that half of the clinicians surveyed used bone scintigraphy as a follow-up method. Although bone recurrence has been evaluated in a variety of ways, most studies use scintigraphic methods as a screening tool, and reports have been in the form of case series or they have evaluated only small registries [9,10]. Data regarding the value of routine bone scintigraphy in follow-up programs for curative gastrectomy have not been validated.…”

Factors associated with early recurrence after curative surgery for gastric cancer

“…Despite improvements in diagnostic procedures and the introduction of multimodal treatment strategies, patient survival remains dismal owing to early recurrence originating from minimal residual disease [3][4][5][6][7][8] . More than 70% of recurrences and tumor-related deaths occur within 2 years after surgery [9][10][11] , with tumor recurrence being the leading cause of death in patients who undergo curative surgery for gastric cancer.…”

Clivus Metastasis From Gastric Signet Ring Cell Carcinoma After a 10-Year Disease-Free Interval

“…6) In contrast to gastric non-SRC, the most recent reports focusing on early gastric SRC as well as the present case have indicated favorable prognosis and lower rate of metastasis, 4) suggesting the application of less invasive surgery such as laparoscopy-assisted gastrectomy. 7) On the other hand, review of the characteristics of early gastric cancer with bone metastasis found that 67-90% of the primary tumors were of the``diffuse type'' including SRC, and long intervals elapsed from gastrectomy to overt bone metastasis (mean 8 years 5 months) 12) (Table 2). Here we can point out that SRC has characteristics in its tumor behavior which tend to give rise to bone metastasis despite the origin as early gastric cancer, and requires time to form secondary lesions as in the present case.…”