胃癌（GC）的骨髓转移（BMM）是实体瘤中弥散性血管内凝血（DIC）最常见的原因，预后较差。关于 GC 患者使用 BMM 一年后预后改善的研究有限。这是首例患有 BMM 的 GC 患者接受 S-1 加奥沙利铂 (SOX) 治疗 30 个月后存活三年以上的患者的报告。该患者是一名 72 岁女性，患有贫血和高碱性磷酸酶 (ALP) 和碳水化合物抗原 19-9 (CA19-9)。详细检查后，BMM诊断为不并发DIC的GC，并于2018年11月开始SOX方案。六个周期后，转为S-1单药治疗，至2019年11月ALP和CA19-9水平均恢复正常。然而，2021 年 4 月的计算机断层扫描显示多处骨转移。因此，她改用紫杉醇为主的治疗。 2021年11月，患者进一步改用纳武单抗单药治疗，但于2022年3月因DIC去世。伴有BMM的GC容易发生DIC，而SOX方案（包括有效对抗微转移的S-1）可能构成安全的治疗方案和有效的治疗方式。版权所有 © 2024 Suto、Inui 和 Okamura。

Bone marrow metastasis (BMM) of gastric cancer (GC), which is the most common cause of disseminated intravascular coagulation (DIC) among solid tumors, has a poor prognosis. Studies on prognostic improvement beyond one year in patients with GC with BMM are limited. This is the first report of a patient who survived over three years after 30 months of S-1 plus oxaliplatin (SOX) therapy for GC with BMM.The patient was a 72-year-old woman who presented with anemia and high levels of alkaline phosphatase (ALP) and carbohydrate antigen 19-9 (CA19-9). Detailed examination led to the diagnosis with BMM of GC uncomplicated by DIC and the SOX regimen was initiated in November 2018. After six cycles, she was switched to S-1 monotherapy, and both ALP and CA19-9 levels reached normal by November 2019. However, computed tomography in April 2021 showed multiple bone metastases. Therefore, she was switched to paclitaxel-based therapy. In November 2021, the patient was further switched to nivolumab monotherapy, but she succumbed due to DIC in March 2022.GCs with BMM are prone to DIC, and the SOX regimen, which includes S-1 with efficacy against micrometastases, may constitute a safe and effective treatment modality.Copyright © 2024 Suto, Inui and Okamura.