Bone metastasis is a late-onset and unfavorable event in survivors of gastric cancer after radical gastrectomy: Results from a clinical observational cohort

Cheng Zhang; Xiaopeng Zhang; Chong Feng; Yahui Yang; Minmin Xie; Ying Feng; Zhijun Wu; Hui Xu; Changhao Wu; Tai Ma

doi:10.1016/j.cpt.2023.11.003

Bone metastasis is a late-onset and unfavorable event in survivors of gastric cancer after radical gastrectomy: Results from a clinical observational cohort

Cancer Pathog Ther. 2024 Jan;2(1):50-57. doi: 10.1016/j.cpt.2023.11.003.

Authors

Cheng Zhang^{1

2}, Xiaopeng Zhang³, Chong Feng³, Yahui Yang¹, Minmin Xie¹, Ying Feng⁴, Zhijun Wu⁵, Hui Xu^{1

2}, Changhao Wu⁶, Tai Ma¹

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
² Anhui Provincial Cancer Institute/Anhui Provincial Office for Cancer Prevention and Control, Hefei, Anhui 230022, China.
³ Department of Noncommunicable Diseases and Health Education, Hefei Center for Disease Control and Prevention, Hefei, Anhui 230091, China.
⁴ Department of Oncology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, China.
⁵ Department of Oncology, Ma'anshan Municipal People's Hospital, Ma'anshan, Anhui 243099, China.
⁶ Department of Biochemistry and Physiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7HX, United Kingdom.

Abstract

Background: The timing and incidence of recurrent bone metastasis (BM) after radical gastrectomy in patients with gastric cancer (GC) as well as the survival of these patients were not fully understood. The aim of this study was to analyze the data of an observational GC cohort and identify patients who underwent curative gastrectomy and had recurrent BM to describe and clarify the pattern and profile of BM evolution after surgery.

Methods: Data were retrieved from a hospital-based GC cohort, and patients who underwent upfront radical gastrectomy were selected. The time points of specific organ metastatic events were recorded, and the person-year incidence rate of metastatic events was calculated. The latency period of BM events after gastrectomy was measured and compared with that of the other two most common metastatic events, liver metastasis (LM) and distant lymph node metastasis (LNM), using analysis of variance. Propensity score matching and subgroup analysis were used for sensitivity analysis.

Results: A total of 1324 GC cases underwent radical gastrectomy between January 2011 and December 2021. Of these, 67 BM, 218 LM, and 248 LNM occurred before the last follow-up. The incidence of BM events was 1.7/100 person-years, which was approximately 3-fold lower than that of LM and distant LNM events (5.5 and 6.3 per 100 person-years, respectively). BM events had a significantly longer latency (median time, 16.5 months) than LM and LNM events (11.1 and 12.0 months, respectively). Recurrent BM led to a worse prognosis (median survival, 4.5 months) than those of LM and LNM events (median survival, 7.7 and 7.1 months, respectively). However, no difference in overall survival after gastrectomy was observed among the groups.

Conclusions: Compared with other common metastatic events, BM in GC after gastrectomy is a late-onset event indicating poor survival.

Trial registration: No. ChiCTR1800019978; http://www.chictr.org.cn/.

Keywords: Incidence; Neoplasm metastasis; Propensity score; Stomach neoplasms; Survival analysis.

Grants and funding

R01 AG049321/AG/NIA NIH HHS/United States