• Gastric cancer
• bone metastases
• overall survival
• progression-free survival

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/therapy
• Bone Neoplasms/secondary
• Bone Neoplasms/mortality
• Bone Neoplasms/therapy
• Female
• Male
• Middle Aged
• Prognosis
• Aged
• Retrospective Studies
• Adult
• Aged, 80 and over
• Alkaline Phosphatase/blood

• 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

• Gastric cancer (GC)
• disease
• epidemiology
• pulmonary metastasis
• risk factors

• Gastric cancer
• Gastrointestinal Stromal Tumors
• Haematology (drugs and medicines)
• Malignant disease and immunosuppression
• Pathology

• Humans
• Male
• Stomach Neoplasms/pathology
• Stomach Neoplasms/secondary
• Bone Marrow Neoplasms/secondary
• Adenocarcinoma/secondary
• Adenocarcinoma/pathology
• Middle Aged
• Fatal Outcome
• Bone Marrow/pathology
• Thrombocytopenia

• 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

• Angiogenesis
• Apoptosis
• Beta blockers
• Cardio-oncology
• Hypertension
• Metastasis

• Humans
• Antihypertensive Agents/adverse effects
• Adrenergic beta-Antagonists/therapeutic use
• Adrenergic beta-Antagonists/pharmacology
• Hypertension/drug therapy
• Hypertension/epidemiology
• Prognosis

• Incidence
• Neoplasm metastasis
• Propensity score
• Stomach neoplasms
• Survival analysis

• R01 AG049321 NIA NIH HHS

• Bone metastasis
• Gene expression profile
• Genetic alteration
• High-throughput nucleotide sequencing
• Stomach neoplasms

• Humans
• Stomach Neoplasms/pathology
• Gene Expression Profiling
• Prognosis
• Transcriptome
• Genomics
• Tumor Microenvironment
• Retinoblastoma-Binding Protein 2/genetics

• 800-20200545 Seoul National University

• disease free survival
• gastric cancer
• lactate dehydrogenase
• overall survival
• prognosis

• Female
• Humans
• Middle Aged
• Stomach Neoplasms/diagnostic imaging
• Bone Neoplasms/diagnostic imaging
• Bone Neoplasms/pathology
• Bone Neoplasms/secondary
• Radiography
• Prognosis
• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/secondary

Bones are one of the most common target organs for cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. Cancer patients often experience a hypercoagulable state.

To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer (GC).

We conducted a single-center retrospective study and enrolled 454 patients. Clinical information including routine blood examination and coagulation markers were collected before any treatment. Patients were grouped according to the status of BM. Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators. Cutoff values, sensitivity and specificity were based on the maximum Youden index. Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.

Of the 454 enrolled patients, 191 patients were diagnosed with BM. The receiver operating characteristic curve analysis suggested that prothrombin time (PT) [cutoff: 13.25; sensitivity: 0.651; specificity: 0.709; area under receiver operating characteristic curve (AUC) = 0.738], activated partial thromboplastin time (aPTT) (cutoff: 35.15; sensitivity: 0.640; specificity: 0.640; AUC = 0.678) and fibrin degradation products (FDP) (cutoff: 2.75; sensitivity: 0.668; specificity: 0.801; AUC = 0.768) act as novel predictors for BM. Based on multivariate logistic regression analysis, the results showed the independent correlation between PT [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.612-6.194; P = 0.001], aPTT (OR: 2.234; 95%CI: 1.157-4.313; P = 0.017) and FDP (OR: 3.17; 95%CI: 1.637-6.139; P = 0.001) and BM in patients with GC. Moreover, age, carcinoembryonic antigen, erythrocyte and globulin were found to be significantly associated with BM.

Coagulation markers, namely PT, aPTT and FDP, might be potential predictors for screening BM in patients with GC.

• Gastric cancer
• Bone metastasis
• Coagulation markers
• Risk factor
• Activated partial thromboplastin time
• Prothrombin time
• Fibrin degradation products

• bone metastasis
• gastric cancer
• local recurrence
• metastasectomy
• nutritional screening
• osteoporosis
• total gastrectomy

• National Research Foundation of Korea

• 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

• Cerebrospinal fluid
• Gastric cancer
• Leptomeningeal metastases
• Prognosis
• ctDNA

• H2020206126 Natural Science Foundation of Hebei Province of China
• 2016YFC0904503 The National Key Research and Development Program of China

• spinal metastases
• immunohistochemistry
• colorectal adenocarcinoma
• hepatocellular carcinoma
• pancreatic ductal carcinoma

• Paget’s disease
• bone metastasis
• gastric cancer
• osteoblastic metastasis

Disseminated carcinomatosis of the bone marrow (DCBM) is a widespread metastasis with a hematologic disorder that is mainly caused by gastric cancer. Although it commonly occurs as a manifestation of recurrence long after curative treatment, the precise mechanism of relapse from dormant status remains unclear. Granulocyte colony-stimulating factor (G-CSF) can promote cancer progression and invasion in various cancers. However, the potential of G-CSF to trigger recurrence from a cured malignancy has not been reported.

A 55-year-old Japanese woman was diagnosed with Ewing sarcoma localized on the fifth lumbar vertebrae 6 years after curative gastrectomy for T1 gastric cancer. After palliative surgery to release nerve compression, pathological diagnosis of the resected specimen was followed by curative radiation and chemotherapy. During treatment, G-CSF was administered 32 times for severe neutropenia prophylaxis. Eight months after completing definitive treatment, she complained of severe back pain and was diagnosed as multiple bone metastases with DCBM from gastric cancer. Despite palliative chemotherapy, she died of disseminated intravascular coagulation 13 d after the diagnosis. Immunohistochemical examination of the autopsied bone marrow confirmed a diffuse positive staining for the G-CSF receptor (G-CSFR) in the relapsed gastric cancer cell cytoplasm, whereas the primary lesion cancer cells showed negative staining for G-CSFR. In this case, G-CSF administration may have been the key trigger for the disseminated relapse of a dormant gastric cancer.

When administering G-CSF to cancer survivors, recurrence of a preceding cancer should be monitored even after curative treatment.

• Disseminated bone marrow carcinomatosis
• Gastric cancer
• Granulocyte colony-stimulating factor
• Cancer survivor
• Immunostaining
• Case report

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

• CZQM2020016 Xiaodong Li
• BK20211065 Xiao Zheng

• metastatic spinal cord compression
• preclinical markers
• prognostic factors
• prospective trials
• radiotherapy
• survival

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

Gastric cancer is among the most common malignant tumors at home and abroad, because its early symptoms are mostly insidious, which leads to distant metastasis when gastric cancer is first diagnosed. The common metastatic sites of gastric cancer are mainly the liver, lung, and peritoneum, but bone metastasis is relatively rare, and the prognosis of gastric cancer bone metastasis is very poor. Therefore, this study is built on the SEER database to analyze the related risk factors of gastric cancer bone metastasis and related factors affecting the prognosis of gastric cancer patients, aiming at improving clinicians' understanding of clinical diagnosis and prognosis of bone metastasis of gastric cancer, thus reducing misdiagnosis and missed diagnosis.

The SEER database was collected to screen out patients with gastric cancer bone metastases and nonbone metastases matched with them from 2010 to 2016, and the Kaplan-Meier method was used to draw survival curves, and the comparison between survival curves was performed by Log-rank test to analyze the overall survival of the two groups of patient's time. Logistic regression analysis was used to analyze the related risk factors of gastric cancer bone metastasis, and the Cox regression proportional hazard model was used to analyze the relationship between gastric cancer bone metastasis and patient prognosis.

Using Kaplan-Meier survival curve to analyze the 1, 3, and 5-year survival rates of gastric cancer patients with bone metastasis and non-metastasis groups were 14.2%, 1.8%, 0.6% and 71.4%, 44.3%, 36.4%, respectively; the average survival rate of the metastatic group was The time was 4.0 months (95%CI: 3.475~4.525), and the average survival time of the non-metastatic group was 30.0 months (95%CI: 26.778~33.222). The difference between the two groups was statistically significant (χ² = 1076.866, P < 0.001). Multivariate logistic regression analysis showed that race (P = 0.007, OR = 1.296), grade (P < 0.001, OR = 0.575), marital status (P < 0.001, OR = 0.040), tumor size (P = 0.006, OR = 0.752), TNM stage (P < 0.001), T stage (P = 0.023, OR = 0.882), and M stage (P < 0.001, OR = 44.958) are independent risk factors for gastric cancer bone metastasis. The Cox univariate analysis suggests that gastric cancer bone metastasis is a risk factor for the prognosis of gastric cancer patients. The Cox multivariate analysis validates that gastric cancer bone metastasis (HR = 0.584, 95% CI: 0.497~0.688, P < 0.001) is independent of the overall survival rate of gastric cancer patients.

Race, grade, marital status, tumor size, TNM stage, T stage, and M stage are independent risk factors for gastric cancer bone metastasis; and gastric cancer bone metastasis is an independent risk factor that affects the prognosis of gastric cancer patients. Therefore, for such high-risk groups, large range screening of the above indicators can effectively improve the prognosis of gastric cancer patients to a certain extent.

• 3-D tumor-on-chip models
• bone metastases
• clinical trials targeting bone metastases
• tumor microenvironment

• UG3CA260692 NIH HHS
• T32 HL007899 NHLBI NIH HHS
• T32 GM140935 NIGMS NIH HHS

Purpose: To develop an effective diagnostic model for bone metastasis of gastric cancer by combining ¹⁸F-FDG PET/CT and clinical data.

Materials and Methods: A total of 212 gastric cancer patients with abnormal bone imaging scans based on ¹⁸F-FDG PET/CT were retrospectively enrolled between September 2009 and March 2020. Risk factors for bone metastasis of gastric cancer were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using receiver operating characteristic curves and calibration plots.

Results: The diagnostic power of the binary logistic regression model incorporating skeleton-related symptoms, anemia, the SUVmax of bone lesions, bone changes, the location of bone lesions, ALP, LDH, CEA, and CA19-9 was significantly higher than that of the model using only clinical factors (p = 0.008). The diagnostic model for bone metastasis of gastric cancer using a combination of clinical and imaging data showed an appropriate goodness of fit according to a calibration test (p = 0.294) and good discriminating ability (AUC = 0.925).

Conclusions: The diagnostic model combined with the ¹⁸F-FDG PET/CT findings and clinical data showed a better diagnosis performance for bone metastasis of gastric cancer than the other studied models. Compared with the model using clinical factors alone, the additional ¹⁸F-FDG PET/CT findings could improve the diagnostic efficacy of identifying bone metastases in gastric cancer.

• 18F-FDG PET/CT
• bone metastasis
• clinical factor
• diagnostic model
• gastric cancer

A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.

• bone metastasis
• combined modality therapy
• esophagogastric junction cancer
• gastric intramural metastases

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

Skeletal-related events (SREs) due to bone metastases (BM) significantly impact the morbidity and mortality of cancer patients. The present study sought to investigate clinicopathological characteristics, metastasis-free survival (MFS), and SREs in patients referred to a tertiary orthopedic and trauma center.

Data were retrieved from electronic health records (n=628). Survival curves were estimated utilizing the Kaplan–Meier method. The Cox regression model was used to determine factors influencing MFS based on estimated hazard ratios (HRs).

Breast (55.8%) and lung (18.2%), and lung (32.9%) and prostate (16.8%) cancer were the most common cancer types in our cohort in women and men, respectively. Fifteen percent of patients presented with BM as the first manifestation of tumor disease, 23% had metastasis diagnosis on the same day of primary tumor diagnosis or within 3 months, and 62% developed BM at least 3 months after primary tumor diagnosis. Osteolytic BM were predominant (72.3%) and most commonly affecting the spine (23%). Overall median MFS was 45 months (32 (men) vs. 53 (women) months). MFS was shortest in the lung (median 15 months, 95% CI 8.05–19) and longest in breast cancer (median 82 months, 95% CI 65.29–94). Age (≥ 60 vs. < 60 years) and primary cancer grading of ≥2 vs. 1 revealed prognostic relevance.

Women with breast or lung cancer, men with lung or prostate cancer, age ≥60 years, male sex, and primary cancer grading ≥2 are associated with increased risk for MBD. Intensified follow-up programs may reduce the risk of SREs and associated morbidity and mortality.

• Cancer
• Complications
• Follow-up
• Metastases
• Metastatic bone disease
• Pathological fracture
• SRE
• Skeletal-related events
• Spine
• Tumor board

Disseminated carcinomatosis of the bone marrow (DCBM) is often associated with disseminated intravascular coagulation (DIC) and a poor prognosis. Moreover, the timing of the diagnosis varies. We presented herein the first report of a case of DCBM from gastric cancer that developed rapidly after a gastrectomy.

A 42-year-old male patient was referred to us for gastric cancer. Preoperative laboratory tests were normal. Abdominal computed tomography (CT) revealed no obvious bone metastasis, and he underwent a laparoscopic distal gastrectomy. On postoperative day (POD) 1, laboratory data indicated severe thrombocytopenia. Postoperative bleeding requiring reoperation was found. Afterwards, he complained of lower back pain. His ALP and LDH gradually became elevated. On POD 8, DIC was diagnosed. CT and bone scintigraphy showed multiple, widespread bone metastases. Based on these findings, DCBM from gastric cancer was diagnosed. Systemic chemotherapy was started on POD 12. The DIC subsided during the first course, and he was discharged on POD 21. The patient died of tumor progression 7 months later.

When thrombocytopenia is observed immediately after a gastrectomy for gastric cancer, the possibility of DCBM should be considered.

• Bone marrow metastasis
• Disseminated carcinomatosis of the bone marrow
• Gastrectomy
• Gastric cancer

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

• metastasis
• prognosis
• site
• stomach neoplasms
• surgery

Immune checkpoints comprise diverse receptors and ligands including costimulatory and inhibitory molecules, which play monumental roles in regulating the immune system. Immune checkpoints retain key potentials in maintaining the immune system homeostasis and hindering the malignancy development and autoimmunity. The expression of inhibitory immune checkpoints delineates an increase in a plethora of metastatic tumors and the inhibition of these immune checkpoints can be followed by promising results. On the other hand, the stimulation of costimulatory immune checkpoints can restrain the metastasis originating from diverse tumors. From the review above, key findings emerged regarding potential functions of inhibitory and costimulatory immune checkpoints targeting the metastatic cascade and point towards novel potential Achilles’ heels of cancer that might be exploited therapeutically in the future.

• Immune checkpoints
• Immune system
• Metastasis
• Tumor

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

• clival metastasis
• contrast-enhanced magnetic resonance imaging
• gastric cancer
• radiotherapy

• Aged
• Cranial Fossa, Posterior
• Humans
• Magnetic Resonance Imaging
• Male
• Nivolumab
• Stomach Neoplasms
• Tomography, X-Ray Computed

• 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

• 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

• Bone tumors
• Fluid-fluid levels
• Gastric cancer
• Metastasis

Bones are not considered a frequent metastatic site in patients with colorectal cancer (CRC). The purpose of the present study was to determine the incidence of bone metastases (BM) in CRC, to identify possible risk factors for BM, survival after BM, and effect of treatment of BM including antiresorptive treatment.

A computer-based literature search was carried out using PubMed and EMBASE.

We included 29 studies. One randomized placebo controlled trial (RCT) study, two autopsy studies, five register studies, and twenty retrospective cohort studies. The studies described different cohorts making direct comparison difficult. Three studies analysed the effect of different treatments for BM including one RCT study.

The incidence of bone metastases was 3–7% in patients with CRC, and it was not possible to detect an increase in incidence over time. The most well established risk factors for BM are rectal cancer, having lymph node invasion at surgery of primary tumor, and lung metastases at any time. Other risk factors such as RAS mutation status have been suggested but results are not conclusive. Survival ranges from 5 to 21 months after diagnosis of BM depending on cohort, with survival of about 8 months in unselected patients. Several variables have been suggested as potential prognostic markers but are all poorly investigated. Treatment of BM is not well investigated, though patients seem to benefit from bisphosphonate treatment with regard to lower risk of skeletal related events. This review highlights the need for new research in the area.

• Bisphosphonate treatment
• Bone metastases
• Colorectal cancer
• Incidence
• Risk factors
• Survival

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