Background: Gallbladder carcinoma (GBC) is a rare, aggressive malignancy comprising 0.5% of gastrointestinal cancers. It has poor survival outcomes due to its insidious onset, lack of standardized screening, and limited therapies. Advanced-stage diagnosis with liver, lymph node, and peritoneal metastasis is common, while bone metastasis is rare. The knowledge on bone metastasis in GBC is limited to case reports and small series, and its clinical significance is largely unexplored. Methods: The study extracted the demographic and clinical variables of patients with metastatic (M1) gallbladder adenocarcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2011 and 2020. Descriptive statistics were used to analyze the demographic characteristics. The multivariate Cox regression analysis was used to calculate the hazard ratio. The overall survival (OS) was assessed using the Kaplan–Meier method, and the log-rank test was utilized to compare the survival between the groups. Results: A total of 2724 patients were included in the study. A total of 69% of the patients were female, and the median age was 68 (range 24–90+). A total of 7.4% of the patients had bone metastasis on diagnosis. The multivariate Cox analysis identified bone metastasis as an independent mortality risk factor in metastatic GBC (HR 1.50,p< 0.001). The patients were divided into two age groups: a younger age group (18–74 years) and an older age group (75+ years). In the younger group, the median OS with and without bone metastasis was 3 and 5 months, respectively (p< 0.0001). In the older age group, there was no significant difference in the OS between the patients with and without bone metastasis (p= 0.35). In the younger group who were treated with chemotherapy, the patients with bone metastasis had a significantly worse OS (median OS 5 months vs. 8 months,p< 0.0001). In the untreated group, the patients with bone metastasis in the younger age group had a significantly worse OS (median OS 1 month vs. 2 months,p= 0.014). In the patients with bone metastasis, those who did not receive chemotherapy had a significantly worse OS than those who were treated with chemotherapy in both age groups (younger age group: median OS 1 month vs. 5 months,p< 0.0001 and older age group: median OS 1 month vs. 5 months,p= 0.041). Conclusions: Our findings suggest that the presence of bone metastasis in gallbladder adenocarcinoma is an independent prognostic factor associated with unfavorable survival outcomes in the younger age group (18–74 years). However, in the older age group (75+ years), the presence of bone metastasis did not impact the survival. Treatment with chemotherapy was associated with extended survival in all patients. Thus, early detection and aggressive management of bone metastasis, including the consideration of chemotherapy, may be crucial in improving the OS and quality of life for individuals with gallbladder adenocarcinoma.
背景：胆囊癌是一种罕见的侵袭性恶性肿瘤，占胃肠道癌症的0.5%。由于其起病隐匿、缺乏标准化筛查手段及治疗选择有限，患者生存预后较差。该病常于晚期确诊，多伴有肝、淋巴结及腹膜转移，而骨转移较为罕见。目前关于胆囊癌骨转移的认知仅限于病例报告和小规模病例系列研究，其临床意义尚未得到充分探讨。 方法：本研究从美国监测、流行病学和最终结果（SEER）数据库中提取2011年至2020年间转移性（M1期）胆囊腺癌患者的人口统计学和临床变量。采用描述性统计分析人口学特征，运用多变量Cox回归模型计算风险比。通过Kaplan-Meier法评估总生存期（OS），并采用对数秩检验比较组间生存差异。 结果：研究共纳入2724例患者，其中女性占69%，中位年龄68岁（范围24-90岁以上）。确诊时伴有骨转移的患者占7.4%。多变量Cox分析显示，骨转移是转移性胆囊癌的独立死亡风险因素（HR 1.50，p<0.001）。将患者分为年轻组（18-74岁）和老年组（75岁以上）进行分析。年轻组中，伴与不伴骨转移患者的中位OS分别为3个月和5个月（p<0.0001）；而老年组中，两组患者的OS无显著差异（p=0.35）。在接受化疗的年轻患者中，伴骨转移者的OS显著更差（中位OS 5个月 vs. 8个月，p<0.0001）。在未治疗组中，年轻组伴骨转移患者的OS显著恶化（中位OS 1个月 vs. 2个月，p=0.014）。在骨转移患者中，无论年龄分组，未接受化疗者的OS均显著差于化疗者（年轻组：中位OS 1个月 vs. 5个月，p<0.0001；老年组：中位OS 1个月 vs. 5个月，p=0.041）。 结论：本研究表明，在年轻患者（18-74岁）中，胆囊腺癌伴发骨转移是预后不良的独立预测因素；而在老年患者（75岁以上）中，骨转移的存在不影响生存结局。化疗治疗与所有患者生存期的延长相关。因此，早期发现并积极处理骨转移（包括考虑化疗）可能对改善胆囊腺癌患者的总生存期和生活质量至关重要。
肿瘤(癌症)患者之家