title: Bone metastasis from gastric cancer: the incidence, clinicopathological features, and influence on survival.
abstract: OBJECTIVE
  To evaluate the incidence, clinicopathological characteristics, treatment outcomes, prognostic factors, and survival of gastric cancer patients with bone metastases.
  
  
  METHODS
  Of 4,617 gastric cancer patients who were treated between 2001 and 2013, 176 patients with bone metastases were analyzed.
  
  
  RESULTS
  The incidence of bone metastasis was 3.8%. The most common histopathological subtype was adenocarcinoma (79%) with poor differentiation (60.8%). The median interval from the diagnosis to bone metastasis was 11 months. The median survival time after bone metastasis was 5.4 months. Factors that were associated with longer median survival times included the following: isolated bone metastasis (P=0.004), well-differentiated tumors (P=0.002), palliative chemotherapy (P=0.003), zoledronic acid treatment (P<0.001), no smoking history (P=0.007), and no metastatic gastric cancer at the time of diagnosis (P=0.01). On the other hand, high levels of lactate dehydrogenase (LDH) (hazard ratio [HR]: 1.86; P=0.015), carcinoembryonic antigen (CEA) (HR: 2.04; P=0.002), and carbohydrate antigen (CA) 19-9 (HR: 2.94; P<0.001) were associated with shorter survival times. In multivariate analysis, receiving zoledronic acid (P<0.001) and performance status (P=0.013) were independent prognostic factors.
  
  
  CONCLUSIONS
  Smoking history, poor performance status, poorly differentiated adenocarcinoma, and high levels of LDH, CEA, and CA 19-9 were shown to be poor prognostic factors, while receiving chemotherapy and zoledronic acid were associated with prolonged survival in gastric cancer patients with bone metastases.
authors.affiliation: Ataturk Chest Disease and Chest Surgery Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Fatma Paksoy
authors.initials: FP
authors.lastname: Turkoz
authors.affiliation: Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Solak
authors.affiliation: Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Saadettin
authors.initials: S
authors.lastname: Kilickap
authors.affiliation: Ankara Ataturk Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Arife
authors.initials: A
authors.lastname: Ulas
authors.affiliation: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Esbah
authors.affiliation: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Oksuzoglu
authors.affiliation: Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey.
authors.forename: Suayib
authors.initials: S
authors.lastname: Yalcin
keywords: Bone metastasis; Prognosis; Stomach neoplasms; Survival; Zoledronic acid