胃癌骨转移患者临床病理与预后分析

目的 本文旨在探讨胃癌骨转移患者的临床病理特征,筛选预后因子。方法 回顾性分析2007年4月—2013年12月哈尔滨医科大学附属肿瘤医院的157例胃癌骨转移患者临床资料。结果 157例胃癌骨转移患者中,确诊胃癌至骨转移的中位时间为280.5天。多发骨转移124例,单发骨转移22例。最常见的骨转移部位是脊柱(88.5%)、骨盆(51.6%)和肋骨(51.0%)。多数患者伴有骨外脏器转移(78.3%)。骨转移的胃癌患者病理分化大多较差,以低分化腺癌(69.3%)及印戒细胞癌及粘液腺癌(33.1%)多见。胃癌患者发生骨转移后的中位生存时间为109天。单因素分析显示CEA水平、LDH水平、血红蛋白浓度、白蛋白浓度、伴有骨外转移、化疗及双膦酸盐治疗与胃癌骨转移患者预后有关(P＜0.05)。多因素分析显示CEA水平、伴有骨外转移、化疗和双膦酸盐治疗均是胃癌骨转移预后的独立因素。结论 CEA升高及伴有骨外转移是其独立的不良预后因素,化疗和双膦酸盐药物治疗可能改善患者的预后。

Analysis of clinical pathology and prognosis in patients with gastric cancer & bone metastasis

Objective The study aimed to investigate the clinicopathological features of patients with bone metastasis from gastric cancer and to screen the independent prognostic factors.Methods The clinical data of 157 patients with bone metastasis from gastric cancer in Zhongnan Hospital of Wuhan University from April 2007 to December 2013 was retrospectively analyzed.Results The median time from diagnosis of gastric cancer to bone metastasis was 280.5 days in 157 patients with gastric cancer.There were 124 cases of multiple bone metastases and 22 cases of single bone metastasis.The most common sites of bone metastasis were the spine(88.5%),the pelvis(51.6%)and the ribs(51.0%).Many patients were accompanied by extra-organic metastasis(78.3%).The pathological differentiation of gastric cancer patients with bone metastasis was mostly poor,with poorly differentiated adenocarcinoma(69.3%)and signet ring cell or mucinous adenocarcinoma(33.1%).The median survival time after gastric metastasis in gastric patients was 109 days.Univariate analysis showed that the levels of CEA and LDH,hemoglobin concentration,albumin concentration,extra-osseous metastasis,systemic chemotherapy and bisphosphonate treatment were associated with prognosis of patients with bone metastasis from gastric cancer(P＜0.05).Multivariate analysis showed that the CEA level with extra-osseous metastasis,systemic chemotherapy and bisphosphonate treatment were independent prognostic factors.Conclusion Elevated CEA and extra-osseous metastasis are independent prognostic factors.Chemotherapy and bisphosphonate therapy may improve the prognosis of patients.