Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.555
Peer-review started: September 21, 2020
First decision: October 27, 2020
Revised: November 3, 2020
Accepted: November 10, 2020
Article in press: November 10, 2020
Published online: December 27, 2020
Processing time: 87 Days and 3.6 Hours
Gastric cancer (GC) with bone metastasis is rare, and rib metastasis is even less common. The clinical prognosis of GC with bone metastasis is poor given the lack of an effective treatment.
A 70 year old man was referred to Shaoxing People’s Hospital with left chest pain and slight dyspnea. Chest computed tomography (CT) revealed a metastatic lesion in the left 3rd rib. Esophagogastroduodenoscopy revealed several ulcers in the angle and antrum of the stomach, and tumor biomarkers including CEA and CA-199 were clearly increased. In addition, lymph node metastasis in the lesser curvature of the stomach was identified by positron emission tomography/CT scanning. Further pathological examination confirmed metastatic adenocarcinoma in the rib and medium-low differentiated adenocarcinoma in the gastric space. The patient had GC with rib metastasis, and was clinically staged as T3NxM1 (IVB). Based on multidisciplinary team opinions, the patient received five courses of chemotherapy (CAPOX plus aptinib), and then underwent rib resection and laparoscopic radical distal gastrectomy. The patient started four courses of chemotherapy after surgery, and then capecitabine and aptinib were administered orally for 3 mo. Follow-up was performed on an outpatient basis using abdominal/chest CT and tumor biomarkers. The patient exhibited an overall survival greater than 2 years, and the disease-free survival was approximately 18 mo. His adverse events were tolerable.
The incidence of GC with rib metastases is extremely low, and patients can obtain more benefits from individualized treatment formulated by multidisciplinary team. Chemotherapy plus surgery might represent an alternative option for GC with rib metastasis.
Core Tip: Gastric cancer (GC) with bone metastasis is uncommon, and rib metastasis is even rarer. The prognosis of patients suffering from GC with rib metastasis is extremely poor. We treated a patient with rib oligometastasis of GC individually and surgically, which led to a long-term tumor-free survival. This case revealed a new idea for the treatment of GC with rib metastasis or other bone metastases.