Potential role of coagulation markers in early detection of bone metastasis in gastric cancer: A critical review

Abstract

This letter to the editor involves the article published in the World Journal of Gastrointestinal Oncology. Bone metastasis (BM) in gastric cancer (GC) is uncommon but can be prevalent in autopsy studies. BM significantly impairs quality of life and is frequently underdiagnosed, as sensitive diagnostic tests are only performed after symptoms occur. Imaging is crucial for the diagnosis of BM but is not routinely used for screening and is expensive. Examining laboratory risk factors for BM in GC patients using multivariate analysis could be a more effective approach.

Key Words: Gastric cancer; Bone metastasis; Coagulation markers; Prothrombin time; Activated partial thromboplastin time; Fibrin degradation products; Diagnostic indicators; Oncology

Core Tip: This letter aims to highlight the potential of tests for coagulation markers as cost-effective, non-invasive tools for early detection of bone metastasis in gastric cancer patients. To enhance the study's applicability, it is crucial to clarify patient grouping criteria and imaging methodologies. Additionally, incorporating diverse, multi-center cohorts and exploring a broader range of biomarkers may strengthen the findings of previous studies. Future research should also consider the impact of treatment on biomarker levels and the underlying mechanisms of hypercoagulability in metastasis to improve patients’ outcomes.

TO THE EDITOR

We read with interest the retrospective study by Wang et al[1]. The study investigates the relationship between various coagulation markers and the risk of bone metastasis (BM) in patients with gastric cancer (GC). The study concludes that early screening for BM in GC patients using coagulation markers, such as prothrombin time, activated partial thromboplastin time, and fibrin degradation product, as well as tumor markers like carcinoembryonic antigen and globulin levels, could significantly reduce mortality rates.

The study's robust statistical analysis, employing both univariate and multivariate logistic regression models, firmly establishes the independent predictive value of coagulation markers for BM in GC patients. Clinically, examining coagulation markers as cost-effective and non-invasive tools shows promise for early detection of BM in GC, offering avenues for risk assessment and personalized treatment strategies from an oncological standpoint.

However, we would like to address several points that may further enhance the applicability and impact of this study.

In the methodology section, when selecting the control and experimental groups, the specific criteria for grouping patients based on different variables should be clearly stated. For example, the specific imaging criteria for determining BM, such as the number, size, and location of lesions, should be clearly defined. Whether there is a standardized diagnostic scoring system or index to quantify the degree of BM should be mentioned. It should also be clarified whether other primary tumors or diseases that can cause BM have been excluded, and how the authors confirmed that the BM in the included patients was due to GC. The measures taken to ensure the consistency and accuracy of imaging diagnosis, such as independent evaluation by multiple experts, should be described. Whether pathological confirmation or follow-up was conducted to verify the accuracy of the imaging diagnosis should also be stated. When grouping, whether other relevant factors, such as tumor stage, treatment status, and underlying diseases, were considered to ensure comparability between groups should be explained. If there are vague or subjective grouping criteria, the measures taken to improve the objectivity and repeatability of the grouping should be described to reduce selection bias[2,3].

The study cohort was derived from a single center, which might limit the generalizability of the findings. Multi-center studies with more diverse populations could provide more robust data and validate the predictive utility of coagulation markers across different demographic groups.

The study currently excludes post-treatment data, potentially missing the effects of treatment on biomarker levels and BM. To address this, it is suggested that both pre-treatment and post-treatment data should be included to better assess these impacts. While the study indicates that coagulation markers could predict BM, it fails to explore the therapeutic implications or interventions that could modify these markers for improved patient outcomes. Dynamically monitoring changes in biomarker levels could provide more predictive value for BM, and further research is needed to understand the impact of these biomarkers on patient survival, quality of life, and treatment decisions.

The study, through STEPP analysis, highlights the potential of HAND2-AS1, PRKAA2, and VLDLR in predicting the risk of peritoneal metastasis in different Lauren types of GC, emphasizing the critical role of biomarkers in various forms of GC metastasis. This could complement the current findings and further emphasize the broader potential of biomarkers in managing metastatic GC[2]. The study primarily focused on coagulation indicators and several tumor markers. Exploring and incorporating more potential biomarkers, such as circulating tumor cells[3], circulating tumor DNA[4], and extracellular vesicles[5], may provide a more comprehensive understanding of the coagulation characteristics in GC patients. While the study presents a solid correlation between coagulation markers and BM, the underlying biological mechanisms remain speculative[6]. Future research should aim to elucidate the pathophysiological pathways connecting hypercoagulability and metastasis, which could pave the way for targeted therapies. Prospective studies are needed to confirm these findings and establish causality more robustly.

In conclusion, the study by Wang et al[1] makes a significant contribution to the existing literature on GC and BM. Their findings highlight the importance of coagulation markers in the early detection of BM, which could lead to improved patient management and outcomes. These valuable data can be leveraged across various clinical domains to enhance diagnostic accuracy, prognostic assessments, and therapeutic strategies for GC patients. We commend the authors for their meticulous research and look forward to future studies that build upon these findings, ultimately benefiting patient care.