Bone Metastasis Mediates Poor Prognosis in Early-Onset Gastric Cancer: Insights Into Immune Suppression, Coagulopathy, and Inflammation

被引：0

作者：

Yin, Shi ^{[1
]}

Zhai, Xiaohui ^{[2
,3
,4
]}

Li, Yaoying ^{[5
]}

Zeng, Ruixin ^{[6
]}

Zhang, Di ^{[7
]}

Sun, Xiaoqing ^{[8
]}

Zhang, Ziying ^{[9
,10
]}

Wang, Huashe ^{[11
]}

Wang, Caiqin ^{[12
]}

机构：

[1] Ningbo Univ, Affiliated Lihuili Hosp, Ningbo, Zhejiang, Peoples R China

[2] Sun Yat Sen Univ, Affiliated Hosp 6, Dept Med Oncol, Guangzhou, Peoples R China

[3] Sun Yat sen Univ, Affiliated Hosp 6, Guangdong Prov Key Lab Colorectal & Pelv Floor Dis, Guangzhou, Peoples R China

[4] Sun Yat Sen Univ, Affiliated Hosp 6, Biomed Innovat Ctr, Guangzhou, Peoples R China

[5] Sun Yat Sen Univ, State Key Lab Oncol South China, Canc Ctr, Guangzhou, Peoples R China

[6] Sun Yat sen Univ, Guangdong Prov Clin Res Ctr Canc, Dept Med Oncol, State Key Lab Oncol South China,Canc Ctr, Guangzhou, Peoples R China

[7] Ningbo Ninth Hosp, Ningbo, Zhejiang, Peoples R China

[8] Sun Yat Sen Univ, Guangdong Prov Clin Res Ctr Canc, Dept Pathol, State Key Lab Oncol South China,Canc Ctr, Guangzhou, Peoples R China

[9] Cent South Univ, Hunan Canc Hosp, Dept Radiat Oncol, Changsha, Hunan, Peoples R China

[10] Cent South Univ, Xiangya Sch Med, Affiliated Canc Hosp, Changsha, Hunan, Peoples R China

[11] Sun Yat Sen Univ, Affiliated Hosp 6, Dept Gastrointestinal Surg, Guangzhou, Peoples R China

[12] Cent South Univ, Affiliated Canc Hosp, Dept Lymphoma & Hematol, Hunan Canc Hosp,Xiangya Sch Med, Changsha, Hunan, Peoples R China

来源：

CANCER MEDICINE | 2025年 / 14卷 / 05期

基金：

中国国家自然科学基金;

关键词：

bone metastasis; cytokines; early-onset gastric cancer; mediation analysis; prognosis; survival analysis; COAGULATION; PLATELETS; CELLS;

D O I：

10.1002/cam4.70737

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BackgroundThe increasing incidence of gastric cancer (GC) in younger populations, coupled with population aging, has highlighted distinct age-related subtypes with unique clinical characteristics and outcomes. Although younger patients tend to have more aggressive tumors, the prognostic factors for early-onset gastric cancer (EOGC) remain underexplored. This study is dedicated to providing a comprehensive and in-depth analysis of prognostic factors in EOGC, aiming to refine personalized treatment strategies under the precision medicine paradigm. MethodsThis retrospective study encompassed 413 local cohort EOGC patients and 8447 Surveillance, Epidemiology, and End Results database patients diagnosed with GC. Survival outcomes were assessed using Kaplan-Meier survival curves, and differences between groups were evaluated with the log-rank test. Prognostic factors were identified through logistic regression and Cox proportional hazards models. Mediation analysis was conducted to assess the indirect effects of clinical factors on EOGC and prognosis. Biomarker comparisons between bone metastasis early-onset gastric cancer and non-bone metastasis early-onset gastric cancer groups were evaluated using the Wilcoxon test for significant differences. ResultsThe overall survival and cancer-specific survival rates in the EOGC group were significantly lower than those in the non-early-onset gastric cancer group (p < 0.05). However, EOGC itself was not an independent risk factor for poor prognosis. Mediation analysis revealed that the adverse impact of EOGC on prognosis was predominantly mediated by metastasis, with bone metastasis identified as the most significant factor. Furthermore, bone metastasis emerged as an independent predictor of poor prognosis in EOGC patients, potentially linked to elevated coagulation markers, increased inflammation-related cytokines, and an imbalance in peripheral blood immune cell ratios. ConclusionsBone metastasis significantly contributes to the poor prognosis of EOGC. EOGC patients with bone metastasis demonstrate immune suppression, inflammation activation, and coagulopathy, highlighting the need for tailored management and prognostic strategies.

引用

页数：12