Abstract
4091 Background: Bone metastasis represents an increasing clinical problem in advanced gastric cancer (GC) as disease-related survival improves. In literature few data on the natural history of bone disease in this malignancy are available. Methods: A retrospective, observational multicenter study aimed to define the natural history of GC patients with bone metastasis was conducted in 22 Italian hospital centres in which these patients received diagnosis and treatment of disease from 1998 to 2011. Data on clinicopathology, skeletal outcomes, skeletal-related events (SREs), and bone-directed therapies for 208 deceased GC patients with evidence of bone metastasis were statistically analyzed. Results: Median time to bone metastasis was 8 months (CI 95%, 6.125–9.875 months) considering all included patients. Median number of SREs/patient was one; less than half of the patients (31%) experienced at least one event and only 4 and 2% experienced at least two and three events, respectively. Median times to first and second SRE were 2 and 4 months, respectively. Median survival was 6 months after bone metastasis diagnosis and 3 months after first SRE. Median survival in patients who did not experience SREs was 5 months. Among patients who received zoledronic acid (ZOL) before the first SRE, median time to its appearance was significantly prolonged compared to control (7 months vs 4 months for control; P:0.0005). Conclusions: To our knowledge, this retrospective analysis is the largest multicenter study to demonstrate that bone metastases from GC are not so rare, are commonly aggressive and result in relatively early onset of SREs in the majority of patients. Furthermore, our large study, which included 90 patients treated with ZOL, showed, for the first time in literature, a significant extension of time to first SRE and increase in the median survival time after diagnosis of bone metastasis.
Highlights
Gastric cancer (GC) is the fourth most common cancer diagnosis worldwide in men following lung, prostate and colorectal, and the fifth in women following breast, colorectal, cervical and lung with an expected incidence of 640,000 and 350,000 cases in 2011, respectively [1]
gastric cancer (GC), allowed to identify 208 patients (10%) with bone metastasis. 59 of them (28%) had bone metastasis at the GC diagnosis and 149 (62%) developed bone metastasis after GC diagnosis. 137/208 patients included in this study (66%) were male, consistent with the well-known male predominance of GC
4.7% of all events is represented by hypercalcemia
Summary
Gastric cancer (GC) is the fourth most common cancer diagnosis worldwide in men following lung, prostate and colorectal, and the fifth in women following breast, colorectal, cervical and lung with an expected incidence of 640,000 and 350,000 cases in 2011, respectively [1]. Bone metastases in GC are mainly osteolytic impairing bone integrity and inducing bone pain They result in significant morbidity for patients from the associated skeletal-related events (SREs), defined as pathologic fractures, the need for radiotherapy for bone pain, surgical interventions to treat or prevent an impending fracture, spinal cord and nerve root compressions, and hypercalcemia [4]. Radiotherapy seems to be the most common SRE in GC patients i.e., approximately 95% of patients receive radiotherapy, 8% of them develop pathologic fractures and another 8% require surgical decompression [4]. Detection and availability of new primary therapies have extended patient survival, thereby leaving patients with bone metastasis at risk of SREs for a longer time. Bone metastasis represents an increasing clinical problem in advanced gastric cancer (GC) as disease-related survival improves. Few data on the natural history of bone disease in GC are available
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