Objective:Influence of clinicopathological characteristics and different therapy patterns on the overall survival of patients with gastric cancer with bone metastasis was investigated. Methods:A total of 146 gastric cancer patients with bone metastasis were enrolled from December 1996 to December 2014. Data of clinicopathological characteristics, treatment methods, and overall survival were collected. Univariate and multivariate analyses were performed using log-rank tests and Cox's proportional hazard model, respec-tively. Results:A total of 51 (34.9%) patients had synchronous metastasis, while 95 (65.1%) had metachronous metastasis. Moreover, 35 (24.0%) patients only had bone metastasis, while 111 (76.0%) patients were complicated with other organ metastases, such as liver (30.0%), peritoneal (24.0%), lung (15.1%), and bone marrow (7.5%). After diagnosis of bone metastasis, bisphosphonates, bone radio-therapy and bone surgery were applied in 99 (67.8%), 34 (23.3%), and 5 (3.4%) patients, respectively. Additionally, 96 (65.6%) patients received palliative chemotherapy. The median overall survival was 5.8 months (95%CI:4.284-7.316). Multivariate analysis revealed that KPS<80 (P=0.030), bone marrow metastasis (P<0.001), elevated serum CA199 (P<0.001), and without palliative chemotherapy (P<0.001) were independent poor prognostic factors. Conclusion:The outcome of gastric cancer with bone metastasis is very poor, espe-cially in patients with bone marrow metastasis, worse KPS, and elevated CA199. Palliative chemotherapy may be beneficial for the sur-vival of these patients.

A cancer of unknown primary (CUP), defined as a histologically confirmed metastatic cancer for which the primary site could not be identified after detailed investigations,accounts for 3%-10% of all malignancies.The diagnostic work-up in CUP relies mainly on imaging and histopathology with specific immunohistochemistry,while approaches of gene expression profiling and epig-enomics help precisely identify the primary site in the genomic era.Nevertheless,these approaches have not been widely used in clini-cal practice.Hence,essential and crucial steps are necessary to facilitate the use of such approaches in clinical practice.CUP is a het-erogeneous group of cancers,with low efficiency under traditional empirical treatment.However,identification of favorable subsets (accounting for 15%-20%)and organ-specific treatments could improve patients' survival.Moreover,molecular detection and applica-tion of next-generation sequencing offer the prospect of individualized targeted therapy with novel agents in CUP.Recently,with the development of immunotherapy,we are looking forward to breakthroughs in targeted therapy and immunotherapy for CUP.

Objective:To review the clinicopathological characteristics and analyze the prognostic factors of hepatoid adenocarcinoma of stomach(HAS).Methods:From August 2012 to June 2017,30 patients with HAS were diagnosed in Daycare of Peking University Cancer Hospital.Clinicopathological data and follow-up information of these patients were retrospectively collected and analyzed.Re-sults:The median age of these 30 patients was 58 years at diagnosis,with a male-to-female ratio of 2.75:1.Twenty-nine patients were confirmed to have lymph node metastases and 7 patients had distant metastases.Ten patients died because of the cancer within the follow-up period.The 1-and 3-year survival rates were 60% and 52%,respectively.Cox multivariate regression revealed that elevated serum CA199 levels,higher lymph node staging,not having undergone radical surgery,and stronger immunohistochemical(IHC)stain-ing intensity of alpha fetoprotein(AFP)were independent poor prognostic factors.Conclusions:Elevated serum CA199 levels,lymph node staging,and IHC staining intensity of AFP are verified in this study as independent risk factors of poor outcome in HAS patients. Early detection and diagnosis of the disease may improve the clinical prognosis.Multidisciplinary team discussions are important in making therapy decisions and radical surgery should be performed whenever possible.

BACKGROUND: Malignant plural effusion (MPE) is one of the most common specimen for liquid biopsy gene detection. This study aims to explore a method for isolating tumor cells from large volume of MPE and evaluate its efficacy and application prospect in gene detection. METHODS: Pleural effusions (>500 mL) from 20 advanced lung cancer patients were obtained by effusion drainage and used to isolate tumor cells with cell separation media Percoll and Ficoll. Cell number and purity were calculated. DNA was extracted from the supernatant (etDNA), total cells and isolated tumor cells of pleural effusion (ETC-DNA) to detect the mutation of tumor-related genes by next-generation sequencing. RESULTS: The median number of cells isolated from malignant pleural effusion was 8.50×10⁴ (interquel range: 9.25×10³-3.75×10⁵), 85.50%±5.80% of the cells were identified as tumor cells. The detection rates of epidermal growth factor receptor (EGFR) gene mutation of etDNA, total cell DNA and ETC-DNA were 70.00%, 50.00% and 70.00%, reseparately, while the median EGFR mutation abundance in 3 components was 16.05% (4.78%-43.06%), 1.09% (0.00%-2.39%), and 33.02% (18.50%-76.70%), respectively. ETC-DNA had good consistency with tissue DNA (P>0.999, kappa=1.000) and etDNA (P>0.999, kappa=1.000). ETC-DNA inclined to have higher EGFR mutation than etDNA, but the result was not statistically significant. CONCLUSIONS Our method can isolate large amount of tumor cells from a large volume of malignant pleural effusion with high purity. Using ETC-DNA as specimen improves the efficacy of gene detection, thus is worth further study.