Abstract
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.
Highlights
The morbidity and mortality rates of gastric cancer have declined in developed countries, this type of cancer is still one of the most common malignant tumors worldwide and the fourth leading cause of death among cancer-related diseases globally (Sung et al, 2021)
The following criteria were used as references to confirm bone metastasis: 1) histopathological examinations; 2) one or more similar bone lesions found in the imaging examination, and follow-up examinations for more than 6 months showing a significant progression of bone lesions
A total of 212 patients with gastric cancer (GC) who met the inclusion criteria were included in the study; 85 patients (40.09%) were diagnosed with bone metastasis (BM), and 127 patients (59.91%) were diagnosed without BM (Table 1)
Summary
The morbidity and mortality rates of gastric cancer have declined in developed countries, this type of cancer is still one of the most common malignant tumors worldwide and the fourth leading cause of death among cancer-related diseases globally (Sung et al, 2021). The incidence of bone metastasis (BM) from gastric cancer is very low, with values ranging from 0.9 to 3.8% (Mikami et al, 2017; Wen et al, 2019; Imura et al, 2020). Patients suffering from GC with coinstantaneous BM usually have a poor prognosis Their median survival time ranges from 4 to 9 months (Mikami et al, 2017; Qiu et al, 2018; Imura et al, 2020) after the diagnosis of bone metastasis. The overall survival rate of patients with GC who received chemotherapy before the diagnosis of BM but without palliative chemotherapy after being diagnosed with BM is low (Wen et al, 2019). Early detection of BM in patients with GC is important for determining a suitable treatment plan and for prognosis
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