Skeletal Complications and Survival in Gastric Cancer Patients with Skeletal Metastases

ABSTRACT Background The skeleton is one of the most frequent sites for metastases in patients with advanced cancer. Several guidelines have been proposed covering diagnosis and management of skeletal metastases in patients with breast and prostate cancer. As skeletal metastases in gastric cancer are less frequent events, there have been limited reports that evaluated the incidence, influence on survival of skeletal metastases and the role of bisphosphonate in the treatment of advanced gastric cancer. Material and methods Between 2002 and 2011, we retrospectively reviewed the medical records of 138 patients with metastatic gastric cancer in our institute. We investigated incidence of skeletal metastases, percentage of patients who developed skeletal-related events (SREs) and differences in the therapeutic outcome between patients with and without skeletal metastases. Results Of the 138 patients, 23 patients (median age: 59.5 years; ranged from 29 to 76) were found to have skeletal metastases during their clinical course. Almost all patients have multiple sites of disease that appeared osteoblastic on radiography. Among them, only three (13%) patients experienced SREs (two had spinal cord compression and one had pathological fracture), because most of the patients died of systemic disease progression before the clinical development of SREs. Of the 23 patients, 18 patients (78.3%) had skeletal metastases at the time of initial diagnosis, and 5 patients (21.7%) developed skeletal metastases later in the course of their disease. For 18 patients who presented skeletal metastases at the diagnosis, the median survival time (MST) was 7.4 months, whereas it was 11 months for those without such metastases. Hematological complications, including microangiopathic hemolytic anemia (MAHA) and disseminated intravascular coagulation (DIC), occurred more often with skeletal metastases than with non-skeletal metastases (44 versus 0.9%, respectively), which may relate to the shorter survival of patients with skeletal metastases. Conclusions Our study suggests that the prognosis of gastric cancer with skeletal metastases is poor. Earlier identification and the novel treatment of skeletal metastases would be crucial for improving survival in this patient group.