胃癌骨转移的临床特点

Clinical characteristics of bone metastasis from gastric cancer

据文献报道胃癌伴有骨转移发生率为0.46%～38%，胃癌伴骨转移的高危因素包括：年轻患者、病理为低分化腺癌、BorrmannⅢ型、浸润深度T3和T4、伴多发淋巴转移和胃体部肿瘤。转移途径半数以上为非门脉系统。胃癌伴骨转移而无肝转移病例占69%，骨转移与淋巴转移区站转移有密切关联，距胃原发病灶3 cm以上存在淋巴转移者，其骨转移发生率为27%。核素扫描为骨转移提供了诊断途径和可靠的依据，HCG、CEA肿瘤标志物检测对诊断骨转移有所帮助，治疗以放化疗为主。骨转移预后较差，大多生存期〈6个月。

The bone is a common site of metastasis for gastric cancer. High-risk factors of metastatic gastric cancer include young age, poorly differentiated adenocarcinoma, Borrmann type III tumors, depth of invasion at Se and Pm levels, positive lymph nodes, and gastric cancer with concomitant body of stomach cancer. More than half of the transfer pathway belongs to the non-portal system. Cases of gastric cancer with bone metastasis but without liver metastasis accounted for 69%of the total gastric cancer cases, whereas the incidence rate of bone metastasis with lymph node metastasis （≥3 cm away from the primary lesion） was 27%. In addition to the tumor markers human chorionic gonadotropin and carcinoembryonic antigen, radionuclide scan of the bone metastasis provides diagnostic pathways and reliable basis for treatment. Chemoradiation and surgery as symptomatic treatments are alternative therapies for stomach cancer. Bone metastasis confers unfavorable prognosis, and the survival time is often less than six months.