作者：郑琪，胡雪玲，廖子君，马婕群，张彦兵，李索妮

单位：西安交通大学医学院附属陕西省肿瘤医院 内一科，陕西 西安 710061

Authors:  ZHENG Qi, HU Xueling, LIAO Zijun, MA Jiequn, ZHANG Yanbing, LI Suoni

Unit: First Department of Medical Oncology, Affiliated Shaanxi Provincial Cancer Hospital, College of Medicine, Xi' an Jiaotong University, Xi'an 710061, Shaanxi, China

摘要：

目的  研究以骨转移为首发症状的胃癌的临床特点。方法  回顾西安交通大学医学院附属陕西省肿瘤医院内一科2013年至2017年胃癌病例,筛选出24例以骨转移为首发症状的患者,分析其临床特点。结果  患者平均年龄61岁;男女比例为2:1;4例患者为单发骨转移,20例患者为多发骨转移;4例患者发病部位为骨盆(髂骨,髋臼),20例患者为多发部位转移(脊柱、肋骨和四肢骨);临床表现为骨痛、病理性骨折、肢体肿胀、行走障碍;多数患者(20/24)存在骨以外的转移;20例患者经ECT确诊骨转移,4例经PET/CT确诊;患者的治疗以止痛、支持治疗为主,配合姑息性放化疗;患者中位生存期为8月。结论  以骨转移为首发症状的胃癌较为罕见。一方面,其原发病隐匿而不易确诊,临床表现和诊疗原则也有其自身特点,另一方面,经过积极治疗后预后优于一般胃癌骨转移。

关键词： 胃癌; 骨转移

Abstract：

Objective  To investigate the features of gastric cancer presenting initially with bone metastases. Methods  From 2013 to 2017, we reviewed gastric cancer patients of the First Department of Medical Oncology, Affiliated Shaanxi Provincial Cancer Hospital, College of Medicine, Xi'an Jiaotong University. Then 24 patients with initial symptoms of bone metastases were chosen to be analyzed on their clinical characteristics. Results  The patients had the average age of 61 years old, the male/ female ratio was 2:1; 4 patients had single bone metastasis and 20 patients had multiple bone metastases; 4 patients had pelvic metastasis (iliac bone and acetabular bone), and 20 patients had bone metastases of other regions (vertebrate, rib and limb bones); the patients had clinical symptoms such as bone ache, pathological fracture, limb swelling and ambulation disorder; most patients(20/24) had extra-bone metastases; 20 patients were diagnosed with bone metastasis by ECT, and the other 4 patients were diagnosed by PET/CT; the therapeutic measures mainly included pain-relieving, supportive methods, and palliative radiotherapy and chemotherapy; the patients had the median survival time of 8 months. Conclusion  Gastric cancer presenting initially with bone metastases is infrequent. On the one hand, its primary focus is too surreptitious to be diagnosed and its clinical manifestations, diagnosis and treatment methods have its own characteristics, on the other hand, it has better prognosis than common gastric cancer with bone metastases after aggressive treatments.

Key Words:  Gastric cancer; Bone metastasis