Clinical Outcome of Patients with Myelophthisic Anemia Arising From Advanced Gastric Cancer

Abstract

Background Although it is not common to encounter patients with myelophthisic anemia arising from advanced gastric cancer, clinical features and optimal treatment are not yet to be elucidated. Prognosis for gastric cancer patients with bone marrow metastases is extremely poor. The current study was performed to evaluate clinical outcome of patients with myelophthisic anemia arising from advanced gastric cancer.

Methods We retrospectively reviewed the medical records of 26 advanced gastric cancer patients with bone marrow metastases between September 1986 and February 2009 at Soonchunhyang University Hospital.ResultsThe median age was 46 years (range 24-61 yeras). All patients had poorly differentiated adenocarcinoma, including 17 signet ring cell carcinomas. The majority of the patients showed thrombocytopenia, anemia, and elevation of lactate dehydrogenase. Sixteen patients (61.5%) were received palliative chemotherapy with a median of 4 cycles. (range, 1-13 cycles). Median survival durations after bone marrow metastases for entire patients were 37 days (95% CI, 12.5-61.5 days). The median survival times from bone marrow involvement were 11 days in the best supportive care group (range 9.5-12.5 days) and 121 days (range 94.7-147.3 days) in the palliative chemotherapy group (p <0.001). Patients died of tumor progression (11 patients, 45%), brain hemorrhage (6 patients, 25%), infection (5 patients, 21%), and DIC (1 patient, 4%). There were no chemotherapy related deaths.

Conclusion It is difficult to decide whether to proceed with aggressive treatment for gastric cancer patients with bone marrow metastases because of the hematologic findings, e.g. anemia, thrombocytopenia, and DIC. However, this study suggests that palliative chemotherapy should be actively considered in patients with myelophthisic anemia arising from advanced gastric cancer.