[摘 要] 目的：分析胃癌骨转移患者的临床病理特征及影响预后的因素，探讨不同治疗方案对同时与异时骨转移患者生存的 影响。方法：纳入2015年至2023年间南京大学医学院附属鼓楼医院胃癌骨转移患者120例，其中同时骨转移36例，异时骨转移 84例。采用χ2检验比较胃癌同时与异时骨转移患者临床病理特征，采用Cox比例风险回归模型分析影响胃癌骨转移患者骨转移 后总生存期（OS-BM）的风险因素，使用Kaplan-Meier法分析不同治疗方式对同时与异时骨转移OS-BM的影响。结果：120例 胃癌骨转移患者中，有104例（86.6%）合并全身其他器官转移灶。在同时与异时骨转移患者的病理特征比较中，同时骨转移患者 血C-反应蛋白（CRP）升高、血浆白蛋白减少；而异时骨转移患者外周血白细胞以及中性粒细胞低于正常值（均P < 0.05）。异时骨 转移[HR = 2.35, 95% CI（1.47, 3.74），P < 0.01]、血清CA125 ≥ 30.2U/mL [HR = 1.6，95% CI（1.03, 2.48），P = 0.036]、血白细胞 ≥ 9.5 × 109/L [HR = 2.15，95% CI（1.17, 3.92），P = 0.013]，以及未接受免疫治疗[HR = 2.26，95% CI（1.5, 3.39），P < 0.01]是影响患者预 后的独立危险因素。免疫治疗的联合使用相较于未使用免疫治疗，可明显延长胃癌骨转移患者的OS-BM（9.63 vs 4.53个月， P = 0.002）。异时骨转移患者比同时骨转移患者对免疫治疗响应更佳（中位OS-BM：10.8 vs 7.3个月，P = 0.004）。结论：免 疫治疗是胃癌骨转移患者生存的独立保护因素，建议此类患者在化疗基础上尽早采用以免疫治疗为主的联合治疗，以延长患者 的生存期。

[Abstract] Objective: To analyze the clinicopathological characteristics and prognostic factors in gastric cancer patients with bone metastasis, and to evaluate the impact of different treatment regimens on survival in patients with synchronous and metachronous bone metastasis. Methods: A total of 120 gastric cancer patients with bone metastasis treated at Nanjing Drum Tower Hospital between 2015 and 2023 were enrolled, including 36 with synchronous bone metastasis and 84 with metachronous bone metastasis. Clinicopathological features were compared between the two groups using the χ2 test. Cox proportional hazards regression model was employed to identify risk factors for overall survival after bone metastasis (OS-BM). The Kaplan-Meier method was used to analyze the effects of different treatments on OS-BM in both synchronous and metachronous groups. Results: Among the 120 patients, 104 (86.6%) had metastases to other organs. Comparative analysis revealed that synchronous bone metastasis patients exhibited elevated serum C-reactive protein and decreased serum albumin, whereas metachronous bone metastasis patients had reduced peripheral white blood cell and neutrophil counts (all P < 0.05). Metachronous bone metastasis (HR = 2.35, 95% CI [1.47, 3.74], P < 0.01), serum CA125 ≥ 30.2 U/mL (HR = 1.6, 95% CI [1.03, 2.48], P = 0.036), white blood cell count ≥ 9.5 × 10?/L (HR = 2.15, 95% CI [1.17, 3.92], P = 0.013), and absence of immunotherapy (HR = 2.26, 95% CI [1.5, 3.39], P < 0.01) were independent risk factors affecting patient prognosis. Combined immunotherapy significantly prolonged OS-BM in gastric cancer patients with bone metastasis compared to non-immunotherapy regimens (9.63 vs 4.53 months, P = 0.002). Patients with metachronous bone metastasis demonstrated better response to immunotherapy compared to those with synchronous metastases (median OS-BM: 10.8 vs 7.3 months, P = 0.004). Conclusion:Immunotherapy is an independent protective factor for survival in gastric cancer patients with bone metastasis. Early combination therapy centered on immunotherapy alongside chemotherapy is recommended to prolong survival in such patients.

[基金项目] 国家自然科学基金（No. 82373263；No. 82403835）