• NCDB (national cancer database)
• PRLSRT
• metastatic bone disease
• palliative radiation
• palliative rt fractionation

• bone metastasis
• gastric cancer
• immunotherapy
• poorly cohesive
• prognosis

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Stomach Neoplasms/mortality
• Bone Neoplasms/secondary
• Bone Neoplasms/therapy
• Bone Neoplasms/mortality
• Female
• Male
• Retrospective Studies
• Middle Aged
• Prognosis
• Aged
• Adult
• Kaplan-Meier Estimate

• 2024M751405 China Postdoctoral Science Foundation
• 82373263 National Natural Science Foundation of China
• 82403835 National Natural Science Foundation of China
• BK20240247 Jiangsu Provincial Natural Science Foundation Youth Project
• YKK24084 General Project of Nanjing Health Science and Technology Development Program
• ZDXK202233 Jiangsu Provincial Medical Key Discipline
• China Postdoctoral Science Foundation
• National Natural Science Foundation of China

• bone marrow metastasis
• computed tomography
• gastric cancer
• machine learning
• micrometastasis
• radiomics

• MSIP, 2022R1F1A1071702 National Research Foundation (NRF) grant funded by the Korea government, Ministry of Science and ICT

• gastric tumor
• metastatic gastric adenocarcinoma
• mixed-type gastric adenocarcinoma
• osteoblastic lesions
• osteoblastic metastasis

• SEER
• bone metastases
• gastric cancer
• nomogram
• risk factors

• Humans
• Bone Neoplasms/diagnosis
• Internet
• Nomograms
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/diagnosis
• Adolescent
• Young Adult
• Adult
• Middle Aged
• Aged
• Aged, 80 and over

• bone metastasis
• bone microenvironment
• clinical features
• gastric cancer
• skeletal-related events
• treatment regimens

• CZQM2020016 Xiaodong Li
• BK20211065 Xiao Zheng

Gastric cancer (GC) is a worldwide health condition of major concern, with gastric carcinoma with signet ring cell features being increasingly reported. A 61-year-old woman was admitted to the Emergency department with back pain, gastrointestinal complaints, and weight loss. A lumbar and hip computed tomography (CT) was performed and revealed multiple suspicious secondary bone lesions. Laboratory test results reported anemia, thrombocytopenia, and elevated alkaline phosphatase. On thoracic-abdominal-pelvic CT, multiple bone lesions suggestive of metastases were visible on the vertebral spine, ribs, pelvic bones, and proximal femurs, but no identifiable primary or visceral lesions were described. Upper endoscopy identified a gastric adenocarcinoma, and both gastric and bone lesions, especially bone lesions, contained a relevant amount of signet ring cells. The patient was referred to the Medical Oncology department, however, her condition evolved unfavorably. GC with restricted bone metastasis is rare at presentation and has a poor prognosis. Despite its infrequency, clinicians should consider GC involvement when evaluating secondary suspicious bone lesions.

While 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.

Data 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.

Together 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.

In 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.

• Fine–Gray subdistribution hazard regression
• bone metastasis
• competing risk analysis
• cumulative incidence function
• gastric adenocarcinoma
• large population-based cohort study
• long-term survival

• Artificial intelligence
• Diagnostic
• Endoscopy
• Gastric cancer
• Gastritis
• Therapeutic

• Artificial Intelligence
• Early Detection of Cancer
• Endoscopy, Gastrointestinal
• Humans
• Neural Networks, Computer
• Stomach Neoplasms/diagnostic imaging

Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported in the literature. Nevertheless, it is unclear how the metastatic sites may affect the prognosis. In particular, knowledge about the impact of bone metastases on GC patients’ outcome is scant, and this may be related to the rarity of bone lesions and/or their underestimation at the time of diagnosis. In fact, there is still a lack of specific recommendation for their detection at the diagnosis. Then, the majority of the evidences in this field came from retrospective analysis on very heterogeneous study populations. In this context, the aim of this narrative review is to delineate an overview about the evidences existing about bone metastases in GC patients, focusing on their incidence and biology, the prognostic role of bone involvement, and their possible implication in the treatment choice.

• RANK-L
• bone flare
• metastatic gastric cancer
• stage IV
• target therapy
• treatment

• blood markers
• bone metastasis
• clinical features
• digestive tract
• malignant tumor

Gastric cancer (GC) with bone metastasis is rare, and rib metastasis is even less common. The clinical prognosis of GC with bone metastasis is poor given the lack of an effective treatment.

A 70 year old man was referred to Shaoxing People’s Hospital with left chest pain and slight dyspnea. Chest computed tomography (CT) revealed a metastatic lesion in the left 3rd rib. Esophagogastroduodenoscopy revealed several ulcers in the angle and antrum of the stomach, and tumor biomarkers including CEA and CA-199 were clearly increased. In addition, lymph node metastasis in the lesser curvature of the stomach was identified by positron emission tomography/CT scanning. Further pathological examination confirmed metastatic adenocarcinoma in the rib and medium-low differentiated adenocarcinoma in the gastric space. The patient had GC with rib metastasis, and was clinically staged as T₃N_xM₁ (IVB). Based on multidisciplinary team opinions, the patient received five courses of chemotherapy (CAPOX plus aptinib), and then underwent rib resection and laparoscopic radical distal gastrectomy. The patient started four courses of chemotherapy after surgery, and then capecitabine and aptinib were administered orally for 3 mo. Follow-up was performed on an outpatient basis using abdominal/chest CT and tumor biomarkers. The patient exhibited an overall survival greater than 2 years, and the disease-free survival was approximately 18 mo. His adverse events were tolerable.

The incidence of GC with rib metastases is extremely low, and patients can obtain more benefits from individualized treatment formulated by multidisciplinary team. Chemotherapy plus surgery might represent an alternative option for GC with rib metastasis.

• Gastric cancer
• Rib metastasis
• Chemotherapy
• Apatinib
• Surgery
• Case report

Data on epidemiology and outcome in metastatic stomach carcinoma patients from India are scarce. We aimed to evaluate clinical features and treatment outcome in patients treated at our center.

This is a single institutional review of metastatic gastric carcinoma patients treated between May 2011 and October 2016. Patients who received at least one cycle of chemotherapy were included for modified intent-to-treat survival analysis.

total of 143 patients were diagnosed with metastatic stomach carcinoma with a median age of 56 years (range: 29–86). The most common symptoms were abdominal pain in 112 (78%) patients. The most common site was body in 81 (57%) patients. Common site of metastasis was peritoneum in 86 (60%) and liver in (62%). Seventy-one (50%) patients were eligible for survival analysis. Common chemotherapy regimens were capecitabine-cisplatin in 27 (38%) and EOX in 22 (31%) patients. Survival status could not be assessed in 29 (41%) patients who lost to follow-up. After a median follow-up 9.7 months (range: 0.5–37.7), median progression-free survival (PFS) was 7.9 months (range: 0.5–23.9) and median overall survival (OS) was 12.2 months (range: 0.5–37.7). The Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 and the presence of linitis plastica showed a trend toward inferior PFS (P = 0.052 and 0.053, respectively) only in univariate analysis. Female sex and ECOG PS ≥2 predicted inferior OS in both univariate and multivariate analysis (P = 0.012, 0.02 and 0.03 and 0.05, respectively).

Platinum-based doublet chemotherapy was used in the majority of patients. The overall outcome was comparable to that of the available literature. Female sex and ECOG PS ≥2 predicted the inferior outcome.

• Chemotherapy
• gastric cancer
• metastases

The number of studies on bone metastasis (BM) from gastric cancer (GC) is currently limited. Therefore, the aim of the present study was to investigate the characteristics, skeletal-related events (SREs) and prognosis of GC in patients with BMs. Data from 60 patients with BMs from GC were retrospectively retrieved and patient-, tumor- and BM-related characteristics were analyzed. Kaplan-Meier survival curves were analyzed using the univariate log-rank test. Multivariate analyses were conducted using the Cox proportional hazards model. The median patient age was 63.5 years (range, 26-83 years). Visceral or brain metastases were observed at BM diagnosis in 61.7% of the patients. Multiple BMs were detected in 83.3% and SREs occurred in 76.7% of the patients. The median overall survival (OS) after BM diagnosis and SRE occurrence was 9 months (range, 0-43 months) and 5 months (range, 0-36 months), respectively. On multivariate analysis, poor Eastern Cooperative Oncology Group performance status (P=0.030), the administration of chemotherapy prior to BM diagnosis (P<0.001) and no chemotherapy after BM diagnosis (P=0.002) were significant prognostic factors for unfavorable OS, whereas the non-use of bone-modifying agents (BMAs) was the only independent prognostic factor for poor SRE-free survival (SRS; P=0.022). Among patients without SREs at BM diagnosis, the median SRS duration was 7 months (range, 0-43 months). In conclusion, chemotherapy may confer a survival benefit in GC patients with BMs. In addition, the prognosis for GC patients with BMs presenting with SREs is poor, but treatment with BMAs may prevent or delay the development of SREs.

• bone metastasis
• gastric cancer
• skeletal-related event

• bone metastases
• cohort study
• gastric cancer
• prognosis
• risk factors

• Gastric adenocarcinoma
• bone metastasis
• leptomeningeal involvement
• placental disease
• pregnancy complications

• Gastric small cell cancer
• bone metastases
• neuroendocrine tumor (NET)

• molecular evolution
• protein sequence analyses
• cancer microenvironment

• Carbon/metabolism
• Computational Biology/methods
• Cytoskeletal Proteins/genetics
• Cytoskeletal Proteins/metabolism
• Gastric Mucosa/metabolism
• Genomics/methods
• Humans
• Oxygen/metabolism
• Proteome/genetics
• Proteome/metabolism
• Signal Transduction/genetics
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/pathology
• Tumor Microenvironment/genetics

• National Natural Science Foundation of China (National Science Foundation of China)
• This work was supported by the National Natural Science Foundation of China (No. 31871274), Chongqing Natural Science Foundation and Frontier Research Planning Project (No. cstc2018jcyjA2487), the Scientific and Technological Research Program of Chongqing Municipal Education Commission (No. KJ1600304), and College Student Innovation and Entrepreneurship Training Program of Chongqing Normal University (201810637023).

To investigate the outcome and prognostic factors of surgery in treating gastric cancer spinal metastasis (GCSM).

A total of 17 patients with GCSM who have undertaken spinal surgeries have been identified. Kaplan–Meier method and univariate analysis are adopted to investigate the prognostic factors affecting overall survival (OS) and progression-free survival (PFS).

The median PFS and OS are 11.3 months (95% CI: 7.8–14.9 months) and 11.9 months (95% CI: 8.4–15.4 months), respectively. Postoperatively, all patients had substantial pain relief, with mean visual analog scale score descending from 6.6±1.6 to 3.4±1.2. Meanwhile, patients also showed improved neurological functions, with 8 of them having improvements of at least one level in Frankel classification. Univariate analysis presented that patients with carcinoembryonic antigen (CEA)<6 µg/L (p=0.020), lactate dehydrogenase (LDH)<300 U/L (p=0.012), alkaline phosphatase (ALP)<200 U/L (p=0.007), and Tokuhashi score>6 (p=0.027) show longer OS. Moreover, application of bone cement, low level of ALP (<200 U/L), and LDH (<300 U/L) are associated with longer PFS (p<0.05).

Surgery is an efficient option in treating GCSM, due to its efficacy in pain alleviation, function restoration, and stability reconstruction. Low levels of CEA, LDH, ALP, and high Tokuhashi score (>6) are all favorable factors for better OS, whereas low levels of LDH, ALP, and application of bone cement are related with longer PFS.

• gastric cancer
• spine metastasis
• surgery

• angiogenesis
• cancer metastasis
• fibrin matrix
• hydroxyapatite
• microfluidic platform
• tumor microenvironment
• vascularized tumor

• bone metastasis
• gastric cancer
• incidence

• Adult
• Aged
• Biomarkers, Tumor/genetics
• Bone Neoplasms/epidemiology
• Bone Neoplasms/genetics
• Bone Neoplasms/pathology
• Bone Neoplasms/secondary
• China/epidemiology
• Disease-Free Survival
• Female
• Gastrectomy
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• Risk Factors
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/genetics
• Stomach Neoplasms/pathology

• angiogenesis
• cancer metastasis
• fibrin matrix
• hydroxyapatite
• microfluidic platform
• tumor microenvironment
• vascularized tumor

Gastric cancer frequently spreads to the regional lymph nodes, liver and lungs following surgery or late in the clinical course. However, an initial clinical presentation of bone metastasis in gastric cancer patients is relatively rare. The current study presents two cases of gastric cancer diffusely metastasized to the spinal vertebrae and with a single metastasis to the trapezium, respectively. The initial presentations were an increased alkaline phosphatase level without any symptoms associated with bone metastasis in the first case and a swelling in the right carpometacarpal joint of the thumb in the second case. These clinical manifestations are also extremely rare in gastric cancer with bone metastasis. The study emphasizes that a diagnosis of gastric cancer should be considered in patients with increased alkaline phosphatase without clinical symptoms or with a single bone metastasis.

• S-1
• chemotherapy
• cisplatin
• disseminated bone metastasis
• single bone metastasis
• trapezium

The hematogenous metastatic pattern of gastric cancer (GC) was not fully explored. Here we analyzed the frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from GC patients. Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 2010 to 2014. All of statistical analyses were performed using the Intercooled Stata 13.0 (Stata Corporation, College Station, TX). All statistical tests were two‐sided. Totally, there were 19 022 eligible patients for analysis. At the time of diagnosis, there were 7792 patients at stage IV, including 3218 (41.30%) patients with liver metastasis, 1126 (14.45%) with lung metastasis, 966 (12.40%) with bone metastasis and 151 (1.94%) with brain metastasis. GC patients with lung or liver metastasis have a higher risk of bone and brain metastasis than those without lung nor liver metastasis. Intestinal subtype had significantly higher rate of liver and lung metastasis, while diffuse type was more likely to have bone metastasis. Proximal stomach had significantly higher risk to develop metastasis than distal stomach. African‐Americans had the highest risk of liver metastasis and Caucasian had the highest prone to develop lung and brain metastasis. The median survival for patients with liver, lung, bone, and brain metastasis was 4 months, 3 months, 4 months and 3 months, respectively. It is important to evaluate the status of bone and brain metastasis in GC patients with lung or liver metastasis. Knowledge of metastatic patterns is helpful for clinicians to design personalized pretreatment imaging evaluation for GC patients.

• SEER
• gastric cancer
• metastases

The brain-derived neurotrophic factor (BDNF) activates its receptor, tropomyosin receptor kinase B (TrkB; also called NTRK2) that has been shown to promote the malignant progression of several cancers. In this study, we investigated the clinical and biological significance of the BDNF/TrkB axis in the progression of human gastric cancer. The increased co-expression of the BDNF/TrkB axis was significantly correlated with bone metastatic properties in advanced gastric cancers. BDNF acting via TrkB receptors increased the levels of long pentraxin 3 (PTX3) that was related to bone metastatic status of gastric cancer by enhancing gastric cancer–osteoblastic niche interactions. In bone metastatic gastric cancer, PTX3 knockdown using small interfering RNA significantly inhibited BDNF-induced interactions of cancer cells with osteoblasts. Moreover, BDNF-derived PTX3 induction supported subsequent osteoclastogenesis, and this effect was significantly reversed by PTX3 silencing. These findings suggest that a functional interaction between BDNF/TrkB and PTX3 enhances the osteolysis of bone metastatic gastric cancer, thereby providing potential prognostic factors for the development of bone metastasis of gastric cancer.

• BDNF
• PTX3
• bone metastasis
• gastric cancer
• osteoblast

Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2^nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur (S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving quality of life and survival in patients with resectable primary gastric cancer and bone metastasis.

• Stomach neoplasms
• Gastrectomy
• Bone neoplasms
• Neoplasm metastasis
• Metastasectomy

• Chemotherapy, Adjuvant
• Fatal Outcome
• Gastrectomy
• Gastroscopy
• Humans
• Lumbar Vertebrae/pathology
• Lumbar Vertebrae/surgery
• Magnetic Resonance Imaging
• Male
• Metastasectomy/methods
• Middle Aged
• Osteotomy
• Spinal Neoplasms/secondary
• Spinal Neoplasms/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome

• Adenocarcinoma/pathology
• Adult
• Humans
• Male
• Prognosis
• Spinal Neoplasms/secondary
• Stomach Neoplasms/pathology

The skeleton is a common metastatic site for visceral carcinomas. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. We report an infrequent case of a 60-year-old patient diagnosed having a gastric carcinoma with bone metastasis as the first evidence. She has consulted with worsening backache which started two months priorly.

• Bone metastasis
• adenocarcinoma
• gastric cancer

• Bone marrow metastasis
• Case report
• Recurrent gastric cancer

• Bone metastasis
• Gastric cancer
• Prognostic factor

• High BMD
• bone metastasis
• gastric carcinoma

• Skip metastases
• brain
• micrometastases
• skin
• stump

• Adult
• Aged
• Bone Neoplasms/secondary
• Brain Neoplasms/secondary
• Endoscopy, Gastrointestinal
• Female
• Gastric Mucosa/pathology
• Humans
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Micrometastasis/pathology
• Skin Neoplasms/secondary
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Young Adult

• 2-Deoxy-2-((18)F)fluoro-d-glucose positron emission tomography/computed tomography
• Bone scintigraphy
• Cáncer de estómago
• Gammagrafía ósea
• Gastric cancer
• Tomografía por emisión de positrones-tomografía computarizada con (18)F-2-fluoro-2 deoxi-d-glucosa

• Angiogenesis
• Anti-angiogenic therapy
• Bone metastases
• Gastric cancer
• Osteoclastic bone resorption
• Receptor activator of nuclear factor-κB
• Tryptase inhibitors
• c-Kit receptor tyrosine kinase inhibitors

• Animals
• Antigens, CD34/metabolism
• Benzamides
• Benzamidines
• Bone Neoplasms/pathology
• Bone Neoplasms/secondary
• Bone Resorption
• Bone and Bones/metabolism
• Bone and Bones/pathology
• Disease Progression
• Gabexate/therapeutic use
• Guanidines/therapeutic use
• Humans
• Imatinib Mesylate/therapeutic use
• Immune System
• Mast Cells/cytology
• NF-kappa B/metabolism
• Neovascularization, Pathologic
• Piperidines
• Proto-Oncogene Proteins c-kit/metabolism
• Pyridines
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/pathology
• Thiazoles/therapeutic use
• Tryptases/metabolism

• Bone marrow
• Gastric carcinoma
• Pancytopenia
• Recurrence
• Signet-ring cells

• Bone metastasis
• Prognosis
• Stomach neoplasms
• Survival
• Zoledronic acid

Gastric cancer is a major cause of cancer-related mortality. At the time of diagnosis, majority of the patients usually have unresectable or metastatic disease. The most common sites of metastases are the liver and the peritoneum, but in the advanced stages, there may be metastases to any region of the body. Bone marrow is an important metastatic site for solid tumors, and the prognosis in such cases is poor. In gastric cancer cases, bone marrow metastasis is usually observed in younger patients and in those with poorly differentiated tumors. Prognosis is worsened owing to the poor histomorphology as well as the occurrence of pancytopenia. The effect of standard chemotherapy is unknown, as survival is limited to a few weeks. This report aimed to evaluate 5 gastric cancer patients with bone marrow metastases to emphasize the importance of this condition.

• Bone marrow metastasis
• Poor prognosis
• Stomach neoplasms

Gastric cancer, one of the most common cancers in the world, rarely metastasizes to the ovaries. Ovarian metastases of gastric signet ring cell cancer (SRCC) are referred to as Krukenberg tumors and account for 1–2% of all ovarian cancers. Here, we analyze the characteristics, treatment, and prognosis of patients with Krukenberg tumors.

We retrospectively analyzed the demographic characteristics, treatment modalities, progression-free survival (PFS), and overall survival (OS) of patients who were diagnosed with Krukenberg tumors of gastric cancer origin and who underwent treatment and follow-up between January 2005 and January 2012 in the Ankara Oncology Education and Research Hospital.

Among 1755 patients diagnosed with gastric cancer between January 2005 and January 2012, eight patients (0.45%) with histopathologically identified Krukenberg tumors were enrolled. The median age of the eight patients was 42.2 years (range, 32–69 years). Two (25%) of the patients were stage 3A, two (25%) were stage 3C, and four (50%) were stage 4 at the time of diagnosis. The median PFS was 13.2 months (1–25 months), the median OS after the original diagnosis was 16.7 months (1–41 months), and the median OS after ovarian metastasis was 3.6 months (1–10 months).

Krukenberg tumors were seen particularly in young patients and more frequently during the premenopausal period. The prognosis was poor. When only the ovaries were affected, metastasectomy prolonged the survival time.

• Krukenberg tumor
• gastric cancer
• metastasectomy
• ovary

• Gastric cancer
• adenocarcinoma
• alkaline phosphatase
• bone metastases
• osteosclerotic

• (18)F-FDG PET–CT
• Bone metastasis
• Gastric cancer
• WBBS