Metastasis to bone from gastric cancer: a single centre experience

Saadettin Kılıçkap; Ümit Tapan; Şuayib Yalçın

Metastasis to bone from gastric cancer: a single centre experience

Yıl 2010, Cilt: 32 Sayı: 2, 192 - 198, 11.06.2010

Saadettin Kılıçkap , Ümit Tapan , Şuayib Yalçın

Öz

Abstract

Aim. Bone metastasis is relatively uncommon with gastric carcinoma. Its complications have a negative impact on the quality of life and function of cancer patients. We planned a retrospective study to investigate the incidence and clinicopathological features of bone metastasis form gastric cancer and to explore the therapeutic outcome. Method. We retrospectively reviewed the clinical records of consecutive 253 patients with gastric cancer who admitted Outpatient Clinic of Medical Oncology in Hacettepe University. Result. Of 253 patients with gastric cancer, 26 patients (10.2%) were found to have skeletal metastases. The median age was 56 years. The vertebrae were the most frequent metastatic site (85%). Bone metastasis-related events (BMEs) included fracture, cord compression, severe bone pain, and radiation therapy because of the risk of fracture were found in 15 (58%) patients. Surgical treatment was given to 3 patients because of bone fracture and cord compression. The median survival was 130 days and 1-year survival was 27%. The median duration between diagnosis of skeletal metastasis and death was 68 days. Elevated alkaline phosphatase (ALP) level was associated with short survival. Conclusion. Skeletal metastasis-associated complications may significantly reduce the quality of life. Bone metastasis is a major health problem because of its complications including pain, pathologic bone fractures, and spinal cord compression.

Key words: Gastric cancer; bone metastasis; incidence; survival; complication.

Özet

Amaç. Mide kanserinde kemik metastazı sık değildir. Kemik metastazı komplikasyonları kanser hastalarında fonksiyon ve yaşam kalitesi üzerine olumsuz etkiler yapmaktadır. Çalışmada mide kanseri olgularında kemik metastazı insidansı, klinikopatolojik özellikleri ve tedavi sonuçlarını değerlendirmeyi amaçladık. Yöntem. Hacettepe Üniversitesi Medikal Onkoloji polikliniğine başvuran 253 hastanın klinik kayıtları retrospektif olarak gözden geçirildi. Bulgular. Mide kanserli 253 hastanın 26’sında (%10.2) kemik metastazı bulundu. Ortanca yaş 56 idi. Vertebralar en sık metastaz yeri idi (%85). Fraktür, kord basısı, ciddi kemik ağrısı ve fraktür riski nedeniyle radyoterapi uygulaması gibi kemik metastazı ilişkili olaylar 15 (%58) olguda izlendi. 3 hastaya kord basısı ve kemik fraktürü nedeniyle cerrahi yapıldı. Ortanca sağkalım 130 gün ve 1 yıllık sağkalım %27 idi. Kemik metastazından ölüme kadar geçen ortanca sure 68 gün idi. Yüksek alkalen fosfataz (ALP) düzeyi kısa sağkalımla ilişkili idi. Sonuç. İskelet metastazına bağlı komplikasyonlar yaşam kalitesini anlamlı derecede azaltabilir. Kemik metastazları, ağrı, patolojik kemik kırıkları ve spinal kord bası komplikasyonları nedeniyle önemli bir sağlık sorunudur.

Anahtar kelimeler: Mide kanseri; kemik metastazı; insidans; sağkalım; komplikasyon.

Anahtar Kelimeler

-

Kaynakça

1. Yoshikawa K, Kitaoka H. Bone metastasis of gastric cancer. Jpn J Surg 1983; 13: 173-6.
2. Stoll BA. Natural History, Prognosis, and Staging of Bone Metastases. In Stoll BA, Parbhoo S (eds). Bone Metastasis: Monitoring and Treatment. New York, Raven Press 1983:1-20.
3. Ferlay J, Bray F, Pisani P, Parkin DM. Cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No. 5, version 2.0. Lyon: IARC Press GLOBOCAN, 2004.
4. Guadagni S, Catarci M, Kinoshitá T, Valenti M, De Bernardinis G, Carboni M Causes of death and recurrence after surgery for early gastric cancer. World J Surg 1997; 21: 434-9.
5. Lehnert T, Erlandson RA, Decosse JJ. Lymph and blood capillaries of the human gastric mucosa. A morphologic basis for metastasis in early gastric carcinoma. Gastroenterology 1985; 89: 939-50.
6. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Clin Orthop Relat Res 1995; 312: 4-9.
7. Yamamura Y, Kito T, Yamada E. Clinical evaluation of bone and bone marrow metastasis of gastric carcinoma. Jpn J Gastroenterol Surg 1985; 18: 2288-93.
8. Koga S, Takebayashi M, Kaibara N, Nishidoi H, Kimura O, Kawasumi H, Makino M. Pathological characteristics of gastric cancer that develop hematogeneous recurrence, with special reference to the site of recurrence. J Surg Oncol 1987; 36: 239-42.
9. Carstens SA, Resnick D. Diffuse sclerotic skeletal metastases as an initial feature of gastric carcinoma. Arch Intern Med 1980; 140: 1666-8.
10. Nakanishi H, Araki N, Kuratsu S, Narahara H, Ishikawa O, Yoshikawa H. Skeletal metastasis in patients with gastric cancer. Clin Orthop Relat Res 2004; 423: 208-12.
11. Choi CW, Lee DS, Chung JK, Lee MC, Kim NK, Choi KW, Koh CS. Evaluation of bone metastases by Tc-99m MDP imaging in patients with stomach cancer. Clin Nucl Med 1995; 20: 310-4.
12. Tatsui H, Onomura T, Morishita S, Oketa M, Inoue T. Survival rate of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine 1996; 21: 2143-8.
13. Seto M, Tonami N, Koizumi K, Sui O, Hisada K. Bone metastasis from gastric cancer. Clinical evaluation on bone scintigram. Kaku Igaku 1983; 20: 795-801.
14. Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain 1997; 69: 1-18.
15. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, Chin JL, Vinholes JJ, Goas JA, Zheng M. Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormonerefractory prostate cancer. J Natl Cancer Inst 2004; 96: 879-82.