Assessment of features and prognostic factors of 146 gastric cancer patients with bone metastasis
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摘要:
目的 研究胃癌骨转移患者的临床特征、治疗模式及预后因子。 方法 收集1996年12月至2014年12月北京肿瘤医院收治的146例胃癌骨转移患者临床资料，进行单因素和多因素生存分析。 结果 所有患者中，51例（34.9%）为同时性骨转移，95例为（65.1%）异时性骨转移。35例（24.0%）患者以骨转移为唯一远处转移灶；111例（76.0%）合并其他部位转移，包括肝（30.0%）、腹膜（24.0%）、肺（15.1%）和骨髓（7.5%）。发生骨转移后，99例（67.8%）患者接受双膦酸盐治疗，34例（23.3%）行骨放疗，5例（3.4%）行骨手术；此外，96例（65.6%）患者接受全身化疗。骨转移后患者的中位生存时间（median overall survival，mOS）为5.8个月（95%CI：4.284~7.316）。多因素分析显示KPS < 80分（P=0.030）、存在骨髓转移（P < 0.001）、骨转移后未全身化疗（P < 0.001）、糖类抗原199（carbohydrate antigen 199，CA199）升高（P < 0.001）是独立的不良预后因子。 结论 胃癌骨转移患者预后差，生存期短，尤其是合并骨髓转移、KPS评分较差及CA199升高者，发生骨转移后给予全身化疗可能给患者带来生存获益。 Abstract:Objective Influence of clinicopathological characteristics and different therapy patterns on the overall survival of patientswith gastric cancer with bone metastasis was investigated. Methods A total of 146 gastric cancer patients with bone metastasis wereenrolled from December 1996 to December 2014.Data of clinicopathological characteristics, treatment methods, and overall survivalwere collected.Univariate and multivariate analyses were performed using log-rank tests and Cox's proportional hazard model, respectively. Results A total of 51(34.9%)patients had synchronous metastasis, while 95(65.1%)had metachronous metastasis.Moreover, 35(24.0%)patients only had bone metastasis, while 111(76.0%)patients were complicated with other organ metastases, such as liver(30.0%), peritoneal(24.0%), lung(15.1%), and bone marrow(7.5%).After diagnosis of bone metastasis, bisphosphonates, bone radiotherapy and bone surgery were applied in 99(67.8%), 34(23.3%), and 5(3.4%)patients, respectively.Additionally, 96(65.6%)patientsreceived palliative chemotherapy.The median overall survival was 5.8 months(95% CI: 4.284-7.316).Multivariate analysis revealedthat KPS < 80(P=0.030), bone marrow metastasis(P < 0.001), elevated serum CA199(P < 0.001), and without palliative chemotherapy(P < 0.001) were independent poor prognostic factors. Conclusion The outcome of gastric cancer with bone metastasis is very poor, especially in patients with bone marrow metastasis, worse KPS, and elevated CA199.Palliative chemotherapy may be beneficial for the survival of these patients. -
Key words:
- gastric cancer, /
- bone metastasis /
- clinicopathological feature /
- therapy pattern /
- prognostic factor
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图 1 146例胃癌骨转移患者的中位生存曲线
Figure 1. Overall survival of 146 gastric cancer patients with bone metastasis
图 2 146例不同特征胃癌骨转移患者Kaplan-Meier生存曲线
Figure 2. Kaplan–Meier curves of 146 gastric cancer patients with bone metastasis according to different variants
A. KPS; B. CA199 level; C. Bone marrow metastasis; D. Chemotherapy after bone metastasis
表 1 患者的临床特征（n=146）
Table 1. Characteristics of patients (n=146)
表 2 胃癌骨转移各因素的单因素及多因素生存分析结果（n=146）
Table 2. Univariate and multivariate analyses of the characteristics associated with overall survival (n=146)
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