Clinical outcome of gastric cancer patients with bone marrow metastases

Ji Yeon Kwon, Jina Yun, Han Jo Kim, Kyoung-Ha Kim, Se-Hyung Kim, Sang-Cheol Lee, Hyun Jung Kim, Sang Byung Bae, Chan Kyu Kim, Nam Su Lee, Kyu Taek Lee, Seong Kyu Park, Jong-Ho Won, Dae Sik Hong, Hee Sook Park, Ji Yeon Kwon, Jina Yun, Han Jo Kim, Kyoung-Ha Kim, Se-Hyung Kim, Sang-Cheol Lee, Hyun Jung Kim, Sang Byung Bae, Chan Kyu Kim, Nam Su Lee, Kyu Taek Lee, Seong Kyu Park, Jong-Ho Won, Dae Sik Hong, Hee Sook Park

Abstract

Purpose: The prognosis of gastric cancer patients with bone marrow metastases is extremely poor. The current study was conducted to evaluate the clinical outcomes of advanced gastric cancer patients with bone marrow metastases.

Materials and methods: We retrospectively reviewed the medical records of 26 advanced gastric cancer patients with bone marrow metastases who were treated at Soonchunhyang University Hospital between September 1986 and February 2009.

Results: The median age was 46 years (range, 24 to 61 years). All patients had poorly differentiated adenocarcinoma, including 17 signet ring cell carcinomas. The majority of the patients had thrombocytopenia, anemia, and elevated lactate dehydrogenase levels. Sixteen patients (61.5%) received palliative chemotherapy (median, 4 cycles; range, 1 to 13 cycles). The median overall survival after detection of bone marrow metastases for the cohort of patients was 37 days (95% confidence interval, 12.5 to 61.5 days). The median overall survival after detection of bone marrow involvement was 11 days in the best supportive care group (range, 2 to 34 days) and 121 days (range, 3 to 383 days) in the palliative chemotherapy group (p<0.001). The causes of death were tumor progression (11 patients, 45%), brain hemorrhage (6 patients, 25%), infection (5 patients, 21%), and disseminated intravascular coagulation (1 patient, 4%). There were no chemotherapy-related deaths.

Conclusion: Palliative chemotherapy could be considered in advanced gastric cancer patients with bone marrow metastases as a treatment option.

Keywords: Bone marrow; Drug therapy; Neoplasm metastasis; Stomach neoplasms.

Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimates of overall survival (OS) in all patients.
Fig. 2
Fig. 2
Kaplan-Meier estimates of overall survival: chemo-therapy group vs. supportive care group.

References

    1. Shin HR, Jung KW, Won YJ, Park JG 139 KCCR-affiliated Hospitals. 2002 annual report of the Korea Central Cancer Registry: based on registered data from 139 hospitals. Cancer Res Treat. 2004;36:103–114.
    1. Crivellari D, Carbone A, Sigon R, Buonadonna A, Cannizzaro R, Sorio R, et al. Gastric cancer with bone marrow invasion at presentation: case-report and review of the literature. Tumori. 1995;81:74–76.
    1. Noda N, Sano T, Shirao K, Ono H, Katai H, Sasako M, et al. A case of bone marrow recurrence from gastric carcinoma after a nine-year disease-free interval. Jpn J Clin Oncol. 1996;26:472–475.
    1. Hayes DF. Prognostic and predictive factors revisited. Breast. 2005;14:493–499.
    1. Kobayashi M, Okabayashi T, Sano T, Araki K. Metastatic bone cancer as a recurrence of early gastric cancer: characteristics and possible mechanisms. World J Gastroenterol. 2005;11:5587–5591.
    1. Wiedswang G, Borgen E, Kåresen R, Kvalheim G, Nesland JM, Qvist H, et al. Detection of isolated tumor cells in bone marrow is an independent prognostic factor in breast cancer. J Clin Oncol. 2003;21:3469–3478.
    1. Kusumoto H, Haraguchi M, Nozuka Y, Oda Y, Tsuneyoshi M, Iguchi H. Characteristic features of disseminated carcinomatosis of the bone marrow due to gastric cancer: the pathogenesis of bone destruction. Oncol Rep. 2006;16:735–740.
    1. Tokar M, Bobilev D, Ariad S, Geffen DB. Disseminated intravascular coagulation at presentation of advanced gastric cancer. Isr Med Assoc J. 2006;8:853–855.
    1. Pyrhönen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer. 1995;71:587–591.
    1. Glimelius B, Ekström K, Hoffman K, Graf W, Sjödén PO, Haglund U, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997;8:163–168.
    1. Kim HS, Yi SY, Jun HJ, Lee J, Park JO, Park YS, et al. Clinical outcome of gastric cancer patients with bone marrow metastases. Oncology. 2007;73:192–197.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する