胃癌骨转移的临床特点.pdfVIP

中国肿瘤临床2015年第42卷第9期 Chin J Clin Oncol 2015. Vol. 42. No. 9 ·特约综述· 张高嘉，天津医科大学肿瘤医院腹部肿瘤外科主任医师。天津市癌症康复委员会专 家顾问，全国肿瘤学期刊委员会科学论文特聘审稿人。从事胃肠肿瘤外科工作50余年， 较早在国内开展全胃切除术后P型间置空肠代胃术，改良多种胃肠手术术式，如近端胃次 全切除间置空肠架桥术、空肠襻式架桥引流术、结直肠癌根治术等。以第一作者在核心期 刊发表论文20余篇。 胃癌骨转移的临床特点 张高嘉① 王俊锋① 李万荣① 张云鹏① 沈志祥② 摘要 据文献报道胃癌伴有骨转移发生率为0.46%～38%，胃癌伴骨转移的高危因素包括：年轻患者、病理为低分化腺癌、 Borrmann Ⅲ型、浸润深度T3和T4、伴多发淋巴转移和胃体部肿瘤。转移途径半数以上为非门脉系统。胃癌伴骨转移而无肝转移 病例占69%，骨转移与淋巴转移区站转移有密切关联，距胃原发病灶3 cm以上存在淋巴转移者，其骨转移发生率为27%。核素扫 描为骨转移提供了诊断途径和可靠的依据，HCG、CEA肿瘤标志物检测对诊断骨转移有所帮助，治疗以放化疗为主。骨转移预后 较差，大多生存期6个月。 关键词 胃癌 低分化腺癌 骨转移 转移途径 doi:10.3969/j.issn.1000-8179Clinical characteristics of bone metastasis from gastric cancer Gaojia ZHANG1, Junfeng WANG1, Wanrong LI1, Yunpeng ZHANG1, Zhixiang SHEN2 Correspondence to: Gaojia ZHANG; E-mail: lalune@126.com 1Department of Abdominal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Cen- ter for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China; 2Department of Hematology, Ruijin Hospi- tal, Shanghai Jiaotong University, Shanghai 200025, China. Abstract The bone is a common site of metastasis for gastric cancer. High- risk factors of metastatic gastric cancer include young age, poorly differentiated adenocarcinoma, Borrmann type III tumors, depth of invasion at Se and Pm levels, positive lymph nodes, and gastric cancer with concomitant body of stomach cancer. More than half of the transfer pathway belongs to the non-portal system. Cases of gastric cancer with bone metastasis but without liver metastasis accounted for 69% of the total gastric cancer cases, whereas the incidence rate of bone metastasis with lymph node metastasis (≥3 cm away from the primary lesion) was 27%. In addition to the tumor markers human chorionic gonadotropin and carcinoembryonic antigen, radionuclide scan of the bone metastasis provides diagnostic pathways and reliable basis for treatment. Chemoradiation and surgery as symptomatic treatments are alternative ther