Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2020; 12(12): 555-563
Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.555
Individualized treatment for gastric cancer with rib metastasis: A case report
Yu Zhang, Zhen-Xing Zhang, Zeng-Xin Lu, Fang Liu, Geng-Yuan Hu, Feng Tao, Min-Feng Ye
Yu Zhang, Zhen-Xing Zhang, Geng-Yuan Hu, Feng Tao, Min-Feng Ye, Department of Gastrointestinal Surgery, Shaoxing People's Hospital; Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
Zeng-Xin Lu, Department of Radiology, Shaoxing People's Hospital; Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
Fang Liu, Department of Pathology, Shaoxing People's Hospital; Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
Author contributions: Zhang Y, Zhang ZX, Hu GY, Tao F, and Ye MF performed the treatment; Liu F provided the pathological diagnosis; Lu ZX provided the radiological diagnosis and Zhang Y wrote the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min-Feng Ye, MD, Surgical Oncologist, Department of Gastrointestinal Surgery, Shaoxing People's Hospital; Shaoxing Hospital, Zhejiang University School of Medicine, No. 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China. minfeng_ye@yeah.net
Received: September 21, 2020
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Gastric cancer, Rib metastasis, Chemotherapy, Apatinib, Surgery, Case report

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.