Abstract
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.
Highlights
Gastric cancer (GC) is the third cause of cancer-related death worldwide [1]
Over the last decades the research in GC has focused on the role of novel and targeted treatments, chemotherapy based on a doublet with platin and fluorouracil remains the standard of care for the first-line therapy in case of metastatic disease without overexpression of human epithelial growth factor 2 receptor (HER2) [3]
Regarding the trials investigating the role of immunotherapy in metastatic GC, the Asian phase III ATTRACTION-2 trial, which tested the efficacy of nivolumab in highly pretreated patients, is the only one showing data about the rate of bone metastases (2.2%) [97,98]
Summary
Gastric cancer (GC) is the third cause of cancer-related death worldwide [1]. In particular, even today, survival is dismal, and only 5.5% of patients diagnosed with metastatic GC are alive at 5 years [2]. If the presence of peritoneal disease or of multiple metastatic sites is considered a well-known worse prognostic factor [16], the knowledge about the role of bone metastases or other visceral sites, such as lung, is scant This could be related to the rarity of bone involvement in GC, representing the fifth metastatic site after liver, peritoneum, lymph nodes, and—according to the series—lung. Bone metastases have been typically searched for only in case of appearance of new symptoms (e.g., pain), and a consistent fraction of them have been recognized only post-mortem during autopsy in case of non-symptomatic disease [17] Based on this background, the aim of this narrative review is to describe the evidence existing about bone metastases in GC patients, focusing on their incidence and biology, their prognostic role, and possible implication in the treatment choice
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