Liu Fangqi, Zhao Jiang, Xie Jie, Xie Li, Zhu Ji, Cai Sanjun, Zheng Hongtu, Xu Ye
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China.
Tumour Biol. 2016 Dec;37:16127–16134. doi: 10.1007/s13277-016-5465-4. Epub 2016 Oct 12.
The morbidity of bone metastasis (BM) from colorectal cancer (CRC) is increasing more than ever; however, insufficient research on BM from CRC leads to reduced awareness of the issue. Therefore, the aim of this study was to evaluate the clinical features and prognostic risk factors of CRC patients with BM. Clinical data were retrospectively analyzed for a total of 242 CRC patients with BM. Of the 242 CRC patients with BM, 52 (21.5 %) had bone metastasis alone (BMA) and 190 (78.5 %) had both bone and visceral metastasis (BM&VM). The median survival time (MST) after the diagnosis of BM in all 242 patients was 15.6 months (95 % confidence interval [CI] 12.74-18.46 months). The MST of the BMA group was significantly longer than that of the BM&VM group (29.1 vs. 12.8 months, p = 0.003). Using a Cox proportional hazard model, we identified a high carcinoembryonic antigen (CEA) level and BMA as independent prognostic factors for CRC patients with BM. For the BMA group, the independent prognostic factors were elevated alkaline phosphatase (ALP) and perineural invasion of the primary cancer, which were distinct from the factors for the entire group of BM patients. Furthermore, we found that the BMA patients with multiple sites of BM had similar prognosis to the BM&VM patients. These findings together provide us with a further understanding of BM from CRC and reveal that BMA may be a distinct subset of BM from CRC that has unique independent prognostic factors and a good prognosis.
结直肠癌（CRC）骨转移（BM）的发病率正以前所未有的速度上升；然而，对CRC骨转移的研究不足导致对该问题的认识降低。因此，本研究的目的是评估CRC骨转移患者的临床特征和预后危险因素。对总共242例CRC骨转移患者的临床资料进行了回顾性分析。在这242例CRC骨转移患者中，52例（21.5%）仅有骨转移（BMA），190例（78.5%）同时有骨和内脏转移（BM&VM）。所有242例患者诊断为BM后的中位生存时间（MST）为15.6个月（95%置信区间[CI]12.74 - 18.46个月）。BMA组的MST显著长于BM&VM组（29.1对12.8个月，p = 0.003）。使用Cox比例风险模型，我们确定癌胚抗原（CEA）水平高和BMA是CRC骨转移患者的独立预后因素。对于BMA组，独立预后因素是碱性磷酸酶（ALP）升高和原发癌的神经周围侵犯，这与整个BM患者组的因素不同。此外，我们发现多部位BM的BMA患者与BM&VM患者的预后相似。这些发现共同使我们对CRC骨转移有了进一步的了解，并揭示BMA可能是CRC骨转移的一个独特亚组，具有独特的独立预后因素和良好的预后。
