胃癌骨转移97例临床病理分析

Clinicopathological features and prognosis in 97 gastric cancer patients with bone metastases

目的 探讨胃癌骨转移患者的临床特征及预后.方法 回顾性分析江西省肿瘤医院2008-01-01-2012-12-31收治的97例胃癌骨转移患者的临床资料.结果 97例患者,占同期收治胃癌病例的2.7％（97/3 612）,其中30例（30.9％）为同时性骨转移,67例（69.1％）为异时性骨转移.单发骨转移者20例（20.6％）,多发骨转移77例（79.4％）.骨转移最常见的部位为脊柱（77.3％）、骨盆（41.2％）和肋骨（35.1％）.97例患者中,16例（16.5％）患者以骨转移为唯一远处转移灶,81例（83.5％）合并其他部位转移.76例（78.3％）患者接受了化疗,姑息放疗者17例（17.5％）,81例（83.5％）患者进行了双膦酸盐的治疗.发生骨转移后患者中位生存时间为6.3个月（95％CI：4.94～7.66）,1年生存率为23.7％;化疗组与未接受化疗组患者中位生存时间分别为7.2和4.5个月,x^2=11.504,P=0.001.单因素分析显示,ECOG评分、同时性骨转移、单发骨转移、合并其他部位转移以及化疗与胃癌骨转移患者的预后有关,P值均＜0.05.多因素分析显示,合并其他部位转移、ECOG评分和化疗是影响患者预后的独立因素,P值均＜0.05.结论 胃癌骨转移患者的预后较差,尤其是合并其他部位转移和评分较差患者,化疗可能给部分患者带来生存获益.

OBJECTIVE To investigate the clinical features and prognosis of gastric cancer patients with bone me- tastases. METHODS The clinical data of gastric cancer with bone metastasis were collected and retrospectively analyzed. RESULTS Totally 97 patients were included,accounting for 2.7%（97/3 612） of all gastric cancer cases during the same period in our hospital. Among them, 30 （30.90%oo ） cases with synchronous metastasis and 67 （69.1% ） with metachronous metastasis. Totally 77 （79.4 %） patients were multiple bone metastases, and 20（20.6 %） patients were single bone metastasis. The most common sites of bone involvement were spine （77.3%） ,pelvis （41.2%） and ribs （35.1%）. Eighty-one patients （83.5 % ） were complicated with other organ metastasis, and 16 （ 16.5 % ） cases with bone metastasis only. 78.4 % patients received chemotherapy, 17.5 % experienced the treatment of radiotherapy and the bisphosphonates were used in 83.5% cases. The median survival time of patients with bone metastases was 6.3 months（95 %CI：4. 94-7. 66） and the 1-year survival rate was 23.7%. The median survival time of patients received chemotherapy or not were 7.2 months and 4.5 months respectively （x^2 = 11. 504, P = 0.001）. ECOG score, systemic chemotherapy, synchronous metastasis, solitary bone metastasis and with other organ metastases were prognostic factors by univariate analysis （all P〈 0. 05）. ECOG score, presence with other organ metastases and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis. CONCLUSIONS The outcome of bone metastasis in gastric cancer is very poor,especially in the patients with worse ECOG score and with other metastases. Chemotherapy may have benefit for their survival.