胃癌骨转移患者的临床特点及预后分析  

Clinical characteristics and prognosis analysis of gastric cancer patients with bone metastasis

作　　者：张苗苗 赖敏 李彦婷 安雨 袁文臻[1,2] Zhang Miaomiao;Lai Min;Li Yanting;An Yu;Yuan Wenzhen(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,China;Department of Surgical Oncology,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院肿瘤外科,兰州730000

出　　处：《中华肿瘤杂志》2024年第5期438-448,共11页Chinese Journal of Oncology

基　　金：国家自然科学基金(82260540)。

摘　　要：目的探讨胃癌骨转移的临床特点及预后,分析发生骨转移的影响因素及不同治疗方式的效果,为胃癌骨转移的早期发现和治疗优化提供依据。方法纳入2011年1月至2021年12月兰州大学第一医院收治的胃癌骨转移患者142例,其中单纯骨转移60例,骨转移合并骨外转移82例。纳入同期无远处转移的Ⅲ期胃癌患者和单纯内脏转移的胃癌患者各142例。采用logistic回归分析确定胃癌骨转移的影响因素,采用Cox比例风险回归模型评估胃癌骨转移患者总生存时间(OS)的影响因素。结果142例胃癌骨转移患者,以低分化腺癌为主(123例),45例患者为同时骨转移,肋骨转移(100例)、脊柱转移(88例)和骨盆转移(84例)多见,110例患者为多发骨转移,82例合并骨外其他部位转移。Ⅲ期胃癌组、单纯内脏转移组、单纯骨转移组和骨转移合并骨外转移组4组比较,患者年龄、分化程度、Borrmann分型、碱性磷酸酶、乳酸脱氢酶、血钙、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酸激酶同工酶、淋巴细胞、血红蛋白、血小板、癌胚抗原、糖类抗原19-9(CA19-9)和糖类抗原724差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,Borrmann分型是胃癌骨转移的独立保护因素(3型:OR=0.07,95%CI:0.01~0.64,P=0.018),碱性磷酸酶(OR=2.54,95%CI:1.07~6.01,P=0.034)、血钙(OR=2.71,95%CI:1.15~6.41,P=0.023)、肌酸激酶同工酶(OR=16.33,95%CI:1.83~145.58,P=0.012)、血小板(OR=10.08,95%CI:1.89~53.85,P=0.007)、CA19-9(OR=2.40,95%CI:1.14~5.05,P=0.021)是胃癌骨转移的独立危险因素。Ⅲ期胃癌组、单纯内脏转移组、单纯骨转移组和骨转移合并骨外转移组患者的中位OS分别为47、13、18和6个月,差异有统计学意义(P<0.001)。单纯骨转移患者行原发肿瘤手术治疗的中位OS为中位OS为33个月,优于未手术患者(6个月,P=0.048)。多因素Cox回归分析显示,有骨外转移(HR=2.45,95%CI:1.56~3.85,P<0.001)、血红Objectives To investigate the clinical characteristics and prognosis of bone metastasis of gastric cancer,analyze the influencing factors of bone metastasis and the effects of different treatment methods,and provide a basis for early detection and treatment optimization of bone metastasis of gastric cancer.Methods A total of 142 gastric cancer patients with bone metastasis admitted to the First Hospital of Lanzhou University from January 2011 to December 2021 were enrolled,including 60 cases of simple bone metastasis and 82 cases of bone metastasis combined with extraosseous metastasis.142 patients with stageⅢgastric cancer without distant metastasis and 142 gastric cancer patients with visceral metastasis admitted to this hospital during the same period were also enrolled for comparison.Logistic regression analysis was used to determine the influencing factors of bone metastasis,and the Cox proportional hazards regression model was used to evaluate the influencing factors of overall survival(OS)of patients with bone metastasis.Results Among the 142 patients with bone metastasis,poorly differentiated adenocarcinoma was the main type(123 cases),and 45 patients had simultaneous bone metastasis.Rib metastasis(100 cases),spine metastasis(88 cases),and pelvis metastasis(84 cases)were more common.A total of 110 patients had multiple bone metastasis,and 82 patients had extraosseous metastasis.Results of the stageⅢgastric cancer group,the visceral metastasis group,the bone metastasis group,and the bone metastasis with extraosseous metastasis group were compared.There were significant differences in age,degree of differentiation,Borrmann type,alkaline phosphatase,lactate dehydrogenase,serum calcium,alanine aminotransferase,aspartate aminotransferase,creatine kinase isoenzyme,lymphocyte,hemoglobin,platelet,CEA,CA19-9,and CA724(all P<0.05).Multivariate logistic regression analysis showed that Borrmann type was an independent protective factor of bone metastasis of gastric cancer(type 3:OR=0.07,95%CI:0.01-0.64,P=0.018).A

关 键 词：胃肿瘤 骨转移 预后 

分 类 号：R735.2[医药卫生—肿瘤]