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Liu Y, Liu Y, Wang S, Niu S, Wang L, Xie J, Zhao N, Zhao S, Cheng C, Dai T. Utilizing machine learning algorithms for predicting risk factors for bone metastasis from right-sided colon carcinoma after complete mesocolic excision: a 10-year retrospective multicenter study. Discov Oncol 2024; 15:463. [PMID: 39298052 DOI: 10.1007/s12672-024-01327-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 09/09/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Bone metastasis (BM) occurs when colon cancer cells disseminate from the primary tumor site to the skeletal system via the bloodstream or lymphatic system. The emergence of such bone metastases typically heralds a significantly poor prognosis for the patient. This study's primary aim is to develop a machine learning model to identify patients at elevated risk of bone metastasis among those with right-sided colon cancer undergoing complete mesocolonectomy (CME). PATIENTS AND METHODS The study cohort comprised 1,151 individuals diagnosed with right-sided colon cancer, with a subset of 73 patients presenting with bone metastases originating from the colon. We used univariate and multivariate regression analyses as well as four machine learning algorithms to screen variables for 38 characteristic variables such as patient demographic characteristics and surgical information. The study employed four distinct machine learning algorithms, namely, extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), to develop the predictive model. Additionally, the model was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA), while Shapley additive explanation (SHAP) was utilized to visualize and analyze the model. RESULTS The XGBoost algorithm performed the best performance among the four prediction models. In the training set, the XGBoost algorithm had an area under curve (AUC) value of 0.973 (0.953-0.994), an accuracy of 0.925 (0.913-0.936), a sensitivity of 0.921 (0.902-0.940), and a specificity of 0.908 (0.894-0.922). In the validation set, the XGBoost algorithm had an AUC value of 0.922 (0.833-0.995), an accuracy of 0.908 (0.889-0.926), a sensitivity of 0.924 (0.873-0.975), and a specificity of 0.883 (0.810-0.956). Furthermore, the AUC value of 0.83 for the external validation set suggests that the XGBoost prediction model possesses strong extrapolation capabilities. The results of SHAP analysis identified alkaline phosphatase (ALP) levels, tumor size, invasion depth, lymph node metastasis, lung metastasis, and postoperative neutrophil-to-lymphocyte ratio (NLR) levels as significant risk factors for BM from right-sided colon cancer subsequent to CME. CONCLUSION The prediction model for BM from right-sided colon cancer developed using the XGBoost machine learning algorithm in this study is both highly precise and clinically valuable.
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Affiliation(s)
- Yuan Liu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yuankun Liu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Shuting Wang
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Sen Niu
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Langyu Wang
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Jiaheng Xie
- Department of Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Songyun Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
| | - Chao Cheng
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China.
| | - Teng Dai
- Jiangnan University Medical Center, Wuxi, China.
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Laganà M, Habra MA, Remde H, Almeida MQ, Cosentini D, Pusceddu S, Grana CM, Corssmit EPM, Bongiovanni A, De Filpo G, Lim ES, Zamparini M, Grisanti S, Deutschbein T, Fassnacht M, Fagundes GFC, Pereira MAA, Oldani S, Rota S, Prinzi N, Jimenez C, Berruti A. Adverse skeletal related events in patients with bone-metastatic pheochromocytoma/paraganglioma. Eur J Cancer 2024; 208:114122. [PMID: 39047533 DOI: 10.1016/j.ejca.2024.114122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 07/27/2024]
Abstract
Metastatic pheochromocytomas and paragangliomas (PPGLs) are frequently associated with skeletal complications. Primary objective: to describe the frequency of adverse skeletal related events (SREs) in PPGL patients with bone metastases (BMs). Secondary objectives: to 1) identify predictive and prognostic factors for SREs and 2) obtain information on the effectiveness of bone resorption inhibitors in reducing SRE risk and improving outcomes in term of survival and SREs time onset. In this retrospective multicenter, multinational study, 294 PPGL patients were enrolled. SREs occurred in 90 patients (31 %). Fifty-five patients (19 %) had bone fractures, 47 (16 %) had spinal cord compression, and 11 (4 %) had hypercalcemia. Twenty-two patients (7 %) had more than one SRE. Sixty-four patients (22 %) underwent surgery, and 136 (46 %) underwent radiotherapy. SREs occurred a median of 4.4 months after diagnosis of BM (range, 0-246.6 months). Independent factors associated with reduced risk of SREs in multivariable analysis were I-131-MIBG radionuclide therapy (hazard ratio [HR], 0.536 [95 % CI, 0.309-0.932]; P = .027) and absence of liver metastases (HR, 0.638 [95 % CI, 0.410-0.992]; P = .046). The median overall survival duration was 5.3 year. In multivariable analysis, age younger than 48 years at PPGL diagnosis (HR, 0.558 [95 % CI, 0.3877-0.806]; P = .002), absence of liver metastases (HR, 0.618 [95 % CI, 0.396-0.965]; P = .034), treatment with bisphosphonates or denosumab (HR, 0.598 [95 % CI, 0.405-0.884]; P = .010), and MIBG radionuclide therapy (HR, 0.444 [95 % CI, 0.274-0.718]; P = .001) were associated with a reduced risk of death. SREs occur frequently and early in bone-metastatic PPGL patients but do not negatively impact survival. MIBG radionuclide therapy and treatment with bone resorption inhibitors are associated with favorable outcome.
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Affiliation(s)
- Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hanna Remde
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madson Q Almeida
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia, Hospital das Clínicas & Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy.
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS INT Istituto Nazionale Tumori Milano, Milan, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, IRCCS IEO European Institute of Oncology, Milano, Italy
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST "Dino Amadori"), Meldola, Italy
| | - Giuseppina De Filpo
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Eugenie S Lim
- Department of Endocrinology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Manuel Zamparini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, Wuerzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gustavo F C Fagundes
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia, Hospital das Clínicas & Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Maria Adelaide A Pereira
- Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia, Hospital das Clínicas & Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Simone Oldani
- Department of Medical Oncology, Fondazione IRCCS INT Istituto Nazionale Tumori Milano, Milan, Italy
| | - Simone Rota
- Department of Medical Oncology, Fondazione IRCCS INT Istituto Nazionale Tumori Milano, Milan, Italy
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS INT Istituto Nazionale Tumori Milano, Milan, Italy
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
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3
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Miao G, Liu J, Zhang Y, Zhou G, Wang F, Huang P, Zhang Y, Wang C, Wang Y, Zeng M, Liu L. A scoring system for stratifying the risk of postoperative bone metastases in colorectal cancer. Surgery 2024; 176:660-667. [PMID: 38890102 DOI: 10.1016/j.surg.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/31/2024] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Surveillance recommendations for postoperative high-risk colorectal bone metastases patients remain in a gray area of guidelines. We aimed to develop a risk stratification system to select ideal candidates for follow-up of colorectal bone metastases status. METHODS Postoperative colorectal cancer patients were included to develop a risk-scoring system to predict bone metastases. Risk scores were calculated based on the predictive factors for bone metastases, which were identified using the Cox proportional hazard regression model. Kaplan-Meier curves visualize the differences between risk groups. RESULTS Eight risk factors (age, lymph node metastasis, pathologic tumor deposit, KRAS mutation status, suspicious retroperitoneal lymph node metastasis, lung metastasis status, largest thickness of colorectal cancer lesion, largest short diameter of lymph node) were predictors of colorectal bone metastases and incorporated into the risk scoring system, and the patients were categorized into 2 risk groups. In the low-risk group, the 1, 3, and 5-year colorectal bone metastases rates were 2.4%, 4.6%, and 3.7%, respectively, whereas in the high-risk group, the 1, 3, and 5-year colorectal bone metastases rates were 15.6%, 29.9%, and 44.4%, respectively. The risk scoring system exhibited a C-index of 0.706, 0.795, and 0.841 in 1, 3, and 5 years, respectively. The Kaplan-Meier curve demonstrates that the incidence of colorectal bone metastases was higher in the high-risk group than in the low-risk group (50.5% vs 11.4%, P < .001). CONCLUSION This risk-scoring system may be valuable in predicting colorectal bone metastases in colorectal cancer patients, and we suggest that colorectal bone metastases status surveillance be added in the high-risk group.
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Affiliation(s)
- Gengyun Miao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Jingjing Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Radiology, Dongying People's Hospital, Shandong, China
| | - Guofeng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Fang Wang
- Shanghai United Imaging Intelligence Co, Ltd, Shanghai, China
| | - Peng Huang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yunfei Zhang
- Shanghai United Imaging Intelligence Co, Ltd, Shanghai, China; Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Cheng Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
| | - Liheng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
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4
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Luther L, McGlone PJ, Hardacker KD, Alsoof D, Hayda RA, Terek RM. Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report. Orthop Rev (Pavia) 2024; 16:91505. [PMID: 38469575 PMCID: PMC10927312 DOI: 10.52965/001c.91505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/03/2023] [Indexed: 03/13/2024] Open
Abstract
Case A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Conclusion Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.
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Affiliation(s)
| | | | | | - Daniel Alsoof
- Corresponding Author: Daniel Alsoof Department of Orthopaedic Surgery Brown University, Warren Alpert School of Medicine 1 Kettle Point Avenue Providence, RI 02906
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Ilyas MIM. Epidemiology of Stage IV Colorectal Cancer: Trends in the Incidence, Prevalence, Age Distribution, and Impact on Life Span. Clin Colon Rectal Surg 2024; 37:57-61. [PMID: 38322602 PMCID: PMC10843881 DOI: 10.1055/s-0043-1761447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Colorectal cancer is a common malignancy in men and women. Historically, stage IV colorectal cancer has 10 to 15% five-year survival. Developments in the management of colorectal metastatic disease have helped improve the overall survival of stage IV colorectal cancers from 12 to 30 months with some patients achieving disease-free survival.
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Karabulut S, Afsar CU, Khanmammadov N, Karahan L, Paksoy N, Dogan I, Ferhatoğlu F, Tastekin D. Disease characteristics and prognostic factors of colorectal cancer patients with bone metastasis: A real-world data from Turkey. J Cancer Res Ther 2024:01363817-990000000-00056. [PMID: 38261430 DOI: 10.4103/jcrt.jcrt_392_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Bone metastasis is rarely seen in colorectal cancer (CRC) patients, and there is insufficient data available regarding such cases. The study aimed to identify the prognostic factors and characteristics associated with overall survival in patients with bone metastatic CRC. METHOD Data from bone metastatic CRC patients referred to a high-volume tertiary cancer center in Turkey, between January 2018 and April 2021, were retrospectively collected. The records of 150 consecutive patients treated for bone metastases due to CRC were reviewed. Overall survival curves were generated by the Kaplan-Meier method and analyzed using the log-rank test. RESULTS Median age was 55 years (19-86 years). Bone metastases were more common in men and those with metachronous metastases. The axial skeleton was the most commonly involved site, and patients were frequently presented with single bone metastasis. Peritoneal metastases were significantly correlated with extra-axial metastases (P = 0.002), and radiotherapy was applied to axial metastases significantly, more frequently (P = 0.02). Lung metastasis was also more prevalent in K-RAS mutated patients (P = 0.008). The median survival time from diagnosis of bone metastasis was 8.3 months (95% confidence interval (CI), 5.5-10.6), and the three-year survival rate was 76.9% (95% CI, 69.8-84.0). Multivariate analysis revealed that brain metastases, right-sided colon tumor, high serum ALP, and Ca 19-9 levels were independent poor prognostic factors (P = 0.01, 0.02, <0.001, and 0.04, respectively). CONCLUSIONS The location of CRC correlates significantly with the site of bone metastasis; the prognosis of CRC patients with bone metastasis is very poor, and the significant poor prognostic factors are brain metastases, right-sidedness, high serum ALP, and Ca 19-9 levels. More attention should be paid to bone metastasis in CRC patients.
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Affiliation(s)
- Senem Karabulut
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | | | - Nijat Khanmammadov
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Latif Karahan
- Internal Medicine, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Nail Paksoy
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Izzet Dogan
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Didem Tastekin
- Medical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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7
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Li T, Jing H, Zhang Y, Cao Z, Zhao L, Zhang X, Sun T, Zhang M. Prognostic impact of colorectal cancer patients with bone metastases: a single-center experience. Updates Surg 2023; 75:2245-2256. [PMID: 37976001 DOI: 10.1007/s13304-023-01696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
The incidence of bone metastasis (BM) in colorectal cancer (CRC) patients is low and the prognosis is poor. There is no clear conclusion on the risk factors affecting the survival of CRC patients with BM. The aim of this study was to investigate the factors that may affect the prognosis of CRC patients with BM. The clinical and pathological data of CRC patients with BM were retrospectively analyzed. The overall survival after BM diagnosis was estimated using the Kaplan-Meier method and Log-rank test, and a multivariable cox regression model was used to identify the prognostic factors of overall survival. This study included 178 CRC patients with BM, of whom 151 had left-sided CRC and 27 had right-sided colon cancer. 1124 CRC patients with BM from the SEER database were included to perform a sensitivity analysis of the primary outcome. Multivariate analysis showed that the N staging, site of BM, and primary tumor sidedness (PTS) were independent prognostic factors for CRC with BM. Among them, right-sided colon cancer patients with BM had a poorer prognosis. Sensitivity analyses showed that PTS was an independent prognostic factor in CRC patients with BM. Primary tumor sidedness and N stage may be potential prognostic markers for BM of CRC. The prognosis of N0 stage CRC with BM is better, while the prognosis of right-sided colon cancer is poor.
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Affiliation(s)
- Tianhao Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Zegang Cao
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China
- Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Tianwei Sun
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China.
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 2755-7131, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
- Nankai University School of Medicine, Nankai University, Tianjin, China.
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Liu M, Dong A, Zuo C, Zhu Y, Fu X. Isolated Skull Metastasis With Unusual Spiculated Periosteal Reaction From Rectal Cancer Resembling Osteosarcoma on FDG PET/CT. Clin Nucl Med 2023; 48:1006-1008. [PMID: 37793159 DOI: 10.1097/rlu.0000000000004859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT We describe FDG PET/CT findings in a case of isolated skull metastasis with spiculated periosteal reaction from rectal mucinous adenocarcinoma 8 years after proctectomy. The skull metastasis showed heterogeneous FDG uptake and multiple short spicules of bone producing the sunburst appearance resembling primary osteosarcoma or Ewing sarcoma. Familiarity with this atypical imaging appearance of the bone metastasis from rectal cancer may be helpful for the diagnosis and differential diagnosis.
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Affiliation(s)
- Mingyuan Liu
- From the Department of Neurology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | | | | | - Yan Zhu
- Pathology, The First Affiliated Hospital of Naval Medical University
| | - Xiaoling Fu
- Department of Medical Oncology, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Abrudan R, Abrudan L, Pop O, Zaha DC. A Rare Case of an Occult Primary Tumor With a Profile of Colon Cancer and Synchronous Metastasis in the Lung, Liver, Bone, and Cerebellum: A Case Report and Literature Review. Cureus 2023; 15:e47824. [PMID: 37899904 PMCID: PMC10610348 DOI: 10.7759/cureus.47824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 10/31/2023] Open
Abstract
Occult primary tumors, or cancers of unknown primary site (CUP), are an oncological pathology characterized by the presence of metastases but without being able to determine the presence of the primary tumor. These types of tumors are very rare, and they pose challenges for diagnosis and treatment. Colorectal cancer is the most common type of malignant tumor worldwide and the second most common cause of death. The most common sites of metastasis in colorectal cancer are hepatic and pulmonary. Relatively rare, patients develop brain and bone metastasis. We reported a rare case of an occult primary tumor with a profile of colon cancer and synchronous metastasis in the lung, liver, bone, and cerebellum developed in a woman who was only 51 years old.
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Affiliation(s)
- Ramona Abrudan
- Oncology, Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, Oradea, ROU
| | - Luca Abrudan
- Radiation Oncology, Radiotherapy Laboratory, County Clinical Emergency Hospital Bihor, Oradea, ROU
| | - Ovidiu Pop
- Pathology, Department of Morphological Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU
| | - Dana Carmen Zaha
- Laboratory Medicine, Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU
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10
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Cho WK, Yoo GS, Rim CH, Jeong JU, Chie EK, Ahn YC, Cho HM, Um JW, Suh YG, Chang AR, Lee JH. Differential Perspectives by Specialty on Oligometastatic Colorectal Cancer: A Korean Oligometastasis Working Group's Comparative Survey Study. Cancer Res Treat 2023; 55:1281-1290. [PMID: 37290481 PMCID: PMC10582548 DOI: 10.4143/crt.2023.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Despite numerous studies on the optimal treatments for oligometastatic disease (OMD), there is no established interdisciplinary consensus on its diagnosis or classification. This survey-based study aimed to analyze the differential opinions of colorectal surgeons and radiation oncologists regarding the definition and treatment of OMD from the colorectal primary. MATERIALS AND METHODS A total of 141 participants were included in this study, consisting of 63 radiation oncologists (44.7%) and 78 colorectal surgeons (55.3%). The survey consisted of 19 questions related to OMD, and the responses were analyzed using the chi-square test to determine statistical differences between the specialties. RESULTS The radiation oncologists chose "bone" more frequently compared to the colorectal surgeons (19.2% vs. 36.5%, p=0.022), while colorectal surgeons favored "peritoneal seeding" (26.9% vs. 9.5%, p=0.009). Regarding the number of metastatic tumors, 48.3% of colorectal surgeons responded that "irrelevant, if all metastatic lesions are amendable to local therapy", while only 21.8% of radiation oncologist chose same answer. When asked about molecular diagnosis, most surgeons (74.8%) said it was important, but only 35.8% of radiation oncologists agreed. CONCLUSION This study demonstrates that although radiation oncologists and colorectal surgeons agreed on a majority of aspects such as diagnostic imaging, biomarker, systemic therapy, and optimal timing of OMD, they also had quite different perspectives on several aspects of OMD. Understanding these differences is crucial to achieving multidisciplinary consensus on the definition and optimal management of OMD.
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Affiliation(s)
- Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun,
Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent`s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | - Jun Won Um
- Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Yang-Gun Suh
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang,
Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul,
Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
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Hyung Kim T, Kim J, Lee J, Nam TK, Min Choi Y, Seong J. Vertebral compression fracture after stereotactic ablative radiotherapy in patients with oligometastatic bone lesions from hepatocellular carcinoma. Clin Transl Radiat Oncol 2023; 41:100636. [PMID: 37216046 PMCID: PMC10195846 DOI: 10.1016/j.ctro.2023.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
Background and purpose Stereotactic ablative radiotherapy (SABR) is popularly used to treat bone metastasis. Despite its efficacy, adverse events, including vertebral compression fracture (VCF), are frequently observed. Here, we investigated VCF risk after SABR for oligometastatic vertebral bone metastasis from hepatocellular carcinoma. Materials and methods A total of 84 patients with 144 metastatic bone lesions treated at three institutions between 2009 and 2019 were retrospectively reviewed. The primary endpoint was VCF development, either new or progression of a pre-existing VCF. VCFs were assessed using the spinal instability neoplastic score (SINS). Results Among 144 spinal segments, 26 (18%) had pre-existing VCF and 90 (63%) had soft tissue extension. The median biologically effective dose (BED) was 76.8 Gy. VCF developed in 14 (12%) of 118 VCF-naïve patients and progressed in 20 of the 26 with pre-existing VCF. The median time to VCF development was 6 months (range, 1-12 months). The cumulative incidence of VCF at 12 months with SINS class I, II and III was 0%, 26% and 83%, respectively (p < 0.001). Significant factors for VCF development were pre-existing VCF, soft tissue extension, high BED, and SINS class in univariate analysis, and pre-existing VCF in multivariate analysis. Of the six components of SINS, pain, type of bone lesion, spine alignment, vertebral body collapse, and posterolateral involvement were identified as predictors of VCF development. Conclusion SABR for oligometastatic vertebral bone lesions from HCC resulted in a substantial rate of new VCF development and pre-existing VCF progression. Pre-existing VCF was significant risk factor for VCF development, which require special attention in patient care. Patients with SINS class III should be considered surgical treatment rather than upfront SABR.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Min Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, South Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Makita K, Hamamoto Y, Kanzaki H, Nagasaki K, Takata N, Tsuruoka S, Uwatsu K, Kido T. Factors affecting local control of bone metastases from radioresistant tumors treated with palliative external beam radiotherapy. Discov Oncol 2023; 14:74. [PMID: 37212949 DOI: 10.1007/s12672-023-00651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the factors that affect the local control (LC) of bone metastases from radioresistant carcinomas (renal cell carcinoma, hepatocellular carcinoma [HCC], and colorectal carcinoma [CRC]) treated with palliative external-beam radiotherapy (EBRT). METHODS AND MATERIALS Between January 2010 and December 2020, 211 bone metastases in 134 patients were treated with EBRT in two hospitals (a cancer center and university hospital). Based on follow-up CT, these cases were reviewed retrospectively to evaluate LC at the EBRT site. RESULTS The median EBRT dose (BED10) was 39.0 Gy (range, 14.4-66.3 Gy). The median follow-up time of the imaging studies was 6 months (range, 1-107 months). The 0.5-year overall survival and LC rates of the EBRT sites were 73% and 73%, respectively. Multivariate analysis revealed that the primary sites (HCC/CRC), low EBRT dose (BED10) (≤ 39.0 Gy), and non-administration of post-EBRT bone modifying agents (BMAs) and/or antineoplastic agents (ATs) were statistically significant factors that negatively affected the LC of EBRT sites. In the absence of BMAs or ATs, the EBRT dose (BED10) escalation from 39.0 Gy improved the LC of EBRT sites. Based on ATs administration, the LC of EBRT sites was significantly affected by tyrosine kinase inhibitors and/or immune checkpoint inhibitors. CONCLUSIONS Dose escalation improves LC in bone metastases from radioresistant carcinomas. Higher EBRT doses are needed to treat patients for whom few effective systemic therapies remain available.
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Affiliation(s)
- Kenji Makita
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
- Departments of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Yasushi Hamamoto
- Departments of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Hiromitsu Kanzaki
- Departments of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Kei Nagasaki
- Departments of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan
| | - Noriko Takata
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kotaro Uwatsu
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
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Zaborovskii N, Schlauch A, Shapton J, Denisov A, Ptashnikov D, Mikaylov D, Masevnin S, Smekalenkov O, Murakhovsky V, Kondrashov D. Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1010-1020. [PMID: 36708397 DOI: 10.1007/s00586-023-07548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics. METHODS The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method. RESULTS 12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery. CONCLUSION Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time. LEVEL OF EVIDENCE Level IV (retrospective cohort study).
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Affiliation(s)
- Nikita Zaborovskii
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Adam Schlauch
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA
| | - John Shapton
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA
| | - Anton Denisov
- Traumatología Elgeadi/Hospital Quirónsalud Valle del Henares, Madrid, Spain
- Traumatología Elgeadi/Hospital Quirónsalud San José, Madrid, Spain
- Hospital 12 de Octubre Health Research Institute, Madrid, Spain
| | - Dmitrii Ptashnikov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I.Mechnikov, Saint-Petersburg, Russia
| | - Dmitrii Mikaylov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Sergei Masevnin
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Oleg Smekalenkov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Vladislav Murakhovsky
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA.
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Abstract
BACKGROUND Various prognostic factors have been reported for bone metastases from different primary tumor sites. However, bone metastases from colorectal cancer are very rare, and the prognostic factors have not been investigated in detail. OBJECTIVE This study aimed to identify prognostic factors of bone metastases from colorectal cancer. DESIGN This is a retrospective cohort study using data from a prospectively collected database. SETTINGS This study was conducted at a single tertiary care cancer center in Japan. PATIENTS Patients who developed bone metastases from colorectal cancer during the study period among all patients who received initial treatment for colorectal cancer at our hospital between 2005 and 2016 (n = 4538) were included. MAIN OUTCOME MEASURES Overall survival after diagnosis of bone metastases from colorectal cancer was the main outcome measure. RESULTS Ninety-four patients developed bone metastases during the study period. The 5-year overall survival rate was 11.0%. Multivariable analysis identified the following independent risk factors associated with poor prognosis: ≥70 years of age at diagnosis of bone metastases (HR, 2.48; 95% CI, 1.24-4.95; p < 0.01), curative surgery not performed as initial treatment (HR, 2.54; 95% CI, 1.24-5.19; p = 0.01), multiple bone metastases (HR, 2.44; 95% CI, 1.30-4.57; p < 0.01), albumin level <3.7 g/dL (HR, 3.80; 95% CI, 1.95-7.39; p < 0.01), CEA ≥30 ng/mL (HR, 1.94; 95% CI, 1.09-3.46; p = 0.02), and less than 3 chemotherapy options remaining at diagnosis of bone metastases (HR, 2.83; 95% CI, 1.51-5.30; p < 0.01). The median survival times for patients with 0-2, 3, and 4-6 risk factors were 25.0, 8.8, and 4.3 months, respectively. LIMITATIONS The main limitation is the single-center, retrospective design of this study. CONCLUSIONS Our results may facilitate multidisciplinary decision-making in patients with bone metastases from colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B930 . FACTORES PRONSTICOS DE LAS METSTASIS SEAS DEL CNCER COLORRECTAL EN LA ERA DE LA TERAPIA DIRIGIDA ANTECEDENTES:Se han reportado varios factores pronósticos para las metástasis óseas de diferentes sitios de tumores primarios. Sin embargo, las metástasis óseas del cáncer colorrectal son muy raras y los factores pronósticos no se han investigado en detalle.OBJETIVO:Identificar los factores pronósticos de las metástasis óseas del cáncer colorrectal.DISEÑO:Estudio de cohorte retrospectivo utilizando datos de una base de datos recolectada prospectivamente.ENTORNO CLINICO:Un solo centro oncológico de atención terciaria en Japón.PACIENTES:Se seleccionaron pacientes que desarrollaron metástasis óseas de cáncer colorrectal durante el período de estudio entre todos los pacientes que recibieron tratamiento inicial para el cáncer colorrectal en nuestro hospital entre 2005 y 2016 (n = 4538).MEDIDA DE RESULTADO PRINCIPAL:Supervivencia general después del diagnóstico de metástasis óseas por cáncer colorrectal.RESULTADOS:Noventa y cuatro pacientes desarrollaron metástasis óseas, lo que representa el 2,0% de todos los pacientes con cáncer colorrectal que comenzaron el tratamiento durante el período de estudio. La tasa de supervivencia global a 5 años fue del 11,0 %. El análisis multivariable identificó los siguientes factores de riesgo independientes asociados con mal pronóstico: edad ≥70 años al momento del diagnóstico de metástasis óseas (hazard ratio 2,48, CI del 95 % 1,24-4,95, p < 0,01), cirugía curativa no realizada como tratamiento inicial (hazard ratio 2,54, CI 95 % 1,24-5,19, p = 0,01), metástasis óseas múltiples (hazard ratio 2,44, CI del 95 % 1,30-4,57, p < 0,01), nivel de albúmina <3,7 g/dL (hazard ratio 3,80, CI del 95 % 1,95 -7,39, p < 0,01), antígeno carcinoembrionario ≥30 ng/mL (hazard ratio 1,94, CI del 95 % 1,09-3,46, p = 0,02) y menos de 3 opciones de quimioterapia restantes al momento del diagnóstico de metástasis óseas (hazard ratio 2,83, 95 % CI 1,51-5,30, p < 0,01). La mediana de los tiempos de supervivencia para los pacientes con 0-2, 3 y 4-6 factores de riesgo fue de 25,0, 8,8 y 4,3 meses, respectivamente.LIMITACIONES:Diseño retrospectivo de un solo centro.CONCLUSIÓN:Nuestros resultados pueden facilitar la toma de decisiones multidisciplinares en pacientes con metástasis óseas de cáncer colorrectal. Consulte Video Resumen en http://links.lww.com/DCR/B930 . (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Bone metastases are associated with worse prognosis in patients affected by metastatic colorectal cancer treated with doublet or triplet chemotherapy plus bevacizumab: a subanalysis of the TRIBE and TRIBE2 trials. ESMO Open 2022; 7:100606. [PMID: 36327757 PMCID: PMC9808439 DOI: 10.1016/j.esmoop.2022.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common cancers; ∼20% of patients have metastases at diagnosis, and 50%-60% subsequently develop metachronous metastases. Bone involvement, despite being rare, is usually associated with higher disease burden, worse prognosis, impaired quality of life, and significant health-related cost. In the last few years, following the positive results of the TRIBE and TRIBE2 trials, the association of FOLFOXIRI plus bevacizumab has become the new standard of care for metastatic CRC. Despite being highly efficacious in all subgroups, little is known about the activity of this regimen in patients with bone metastases. PATIENTS AND METHODS We carried out a pooled analysis of TRIBE and TRIBE2 studies focusing on patients with skeletal deposits. RESULTS Our analyses on the whole population showed that patients with baseline bone involvement reported shorter overall survival [OS; 14.0 versus 26.2 months; hazard ratio (HR) 2.04, 95% confidence interval (CI) 1.46-2.87; P < 0.001] and progression-free survival (PFS; 6.2 versus 11.1 months; HR 1.96, 95% CI 1.42-2.69; P < 0.001) compared with those without bone metastases; no significant interaction with the treatment was reported for PFS (P = 0.094) and OS (P = 0.38). Bone metastases had a negative prognostic implication in the multivariate analysis (HR 2.24, 95% CI 1.54-3.26; P < 0.001). Furthermore, patients with bone lesions at first radiological progression (including those with baseline bone metastases) had a shorter OS compared with those who progressed in other sites (10.4 versus 13.2 months; HR 1.48, 95% CI 1.15-1.91; P = 0.002). A trend toward inferior OS (7.5 versus 11 months, HR 1.50, 95% CI 0.92-2.45; P = 0.10) appeared in patients with basal skeletal deposits compared with those with bone involvement at first radiological progression. CONCLUSIONS Our study confirmed the negative prognostic impact of bone metastases in CRC. Furthermore, we demonstrated for the first time that the survival advantage of triplet chemotherapy plus bevacizumab is maintained even in this prognostically unfavorable subgroup.
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Li T, Huang H, Zhang S, Zhang Y, Jing H, Sun T, Zhang X, Lu L, Zhang M. Predictive models based on machine learning for bone metastasis in patients with diagnosed colorectal cancer. Front Public Health 2022; 10:984750. [PMID: 36203663 PMCID: PMC9531117 DOI: 10.3389/fpubh.2022.984750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023] Open
Abstract
Background This study aimed to develop an artificial intelligence predictive model for predicting the probability of developing BM in CRC patients. Methods From SEER database, 50,566 CRC patients were identified between January 2015 and December 2019 without missing data. SVM and LR models were trained and tested on the dataset. Accuracy, area under the curve (AUC), and IDI were used to evaluate and compare the models. Results For bone metastases in the entire cohort, SVM model with poly as kernel function presents the best performance, whose accuracy is 0.908, recall is 0.838, and AUC is 0.926, outperforming LR model. The top three most important factors affecting the model's prediction of BM include extraosseous metastases (EM), CEA, and size. Conclusion Our study developed an SVM model with poly as kernel function for predicting BM in CRC patients. SVM model could improve personalized clinical decision-making, help rationalize the bone metastasis screening process, and reduce the burden on healthcare systems and patients.
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Affiliation(s)
- Tianhao Li
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Honghong Huang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Shuocun Zhang
- Department of General Surgery, Tianjin Hongqiao Hospital, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China,Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China,Tianjin Institute of Coloproctology, Tianjin, China
| | - Tianwei Sun
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China,Tianjin Institute of Coloproctology, Tianjin, China,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China,Nankai University School of Medicine, Nankai University, Tianjin, China,*Correspondence: Xipeng Zhang
| | - Liangfu Lu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China,Liangfu Lu
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China,Tianjin Institute of Coloproctology, Tianjin, China,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China,Nankai University School of Medicine, Nankai University, Tianjin, China,Mingqing Zhang
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Karlsson S, Nyström H. The extracellular matrix in colorectal cancer and its metastatic settling – alterations and biological implications. Crit Rev Oncol Hematol 2022; 175:103712. [DOI: 10.1016/j.critrevonc.2022.103712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
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Miyakawa T, Kawamura H, Honda M, Takano Y, Kinuta S, Kamiga T, Yamazaki S, Muto A, Shiraso S, Yamashita N, Iwao T, Kono K, Konno S. Impact of histological subtype on prognosis in stage IV colorectal cancer: A population-based cohort study. PLoS One 2022; 17:e0264652. [PMID: 35239725 PMCID: PMC8893698 DOI: 10.1371/journal.pone.0264652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are a few established prognostic factors for stage IV colorectal cancer. Thus, this study aimed to evaluate the impact of histological subtypes on prognosis and metastatic patterns in patients with stage IV colorectal cancer. METHODS This was a population-based, multicenter, cohort study. We included consecutive patients diagnosed with stage IV colorectal cancer between 2008 and 2015 at all designated cancer hospitals in Fukushima prefecture, Japan. Patients were classified into two groups according to histological subtypes as follows: poorly differentiated adenocarcinoma (Por), mucinous adenocarcinoma (Muc), or signet-ring cell carcinoma (Sig) and well (Wel) or moderately differentiated adenocarcinoma (Mod). We evaluated the relationship between these histological groups and survival time. After adjusting for other clinical factors, we calculated the hazard ratio for Por/Muc/Sig. RESULTS A total of 1,151 patients were enrolled, and 1,031 and 120 had Wel/Mod and Por/Muc/Sig, respectively. The median overall survival was 19.2 and 11.9 months for Wel/Mod and Por/Muc/Sig, respectively (p < 0.001). The adjusted hazard ratio for Por/Muc/Sig with regard to survival time was 1.42 (95% confidence interval: 1.13-1.77). Por/Muc/Sig had a lower incidence of liver and lung metastases and a higher incidence of peritoneal dissemination and metastasis to rare organs, such as the bone and brain. CONCLUSIONS The Por/Muc/Sig histological subtype was an independent prognostic factor for poor prognosis among patients with stage IV colorectal cancer. The histological subtype may be useful for predicting the prognosis of patients with stage IV colorectal cancer and designing the treatment strategy.
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Affiliation(s)
- Teppei Miyakawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Fukushima, Japan
- Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Fukushima, Japan
- * E-mail:
| | - Hidetaka Kawamura
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Fukushima, Japan
- Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Fukushima, Japan
- Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Fukushima, Japan
| | - Yoshinao Takano
- Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Fukushima, Japan
| | - Shunji Kinuta
- Department of Surgery, The Takeda Healthcare Foundation Takeda General Hospital, Aizu Wakamatsu, Fukushima, Japan
| | - Takahiro Kamiga
- Department of Surgery, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
| | - Shigeru Yamazaki
- Department of Surgery, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan
| | - Atsushi Muto
- Department of Surgery, Fukushima Rosai Hospital, Iwaki, Fukushima, Japan
| | - Satoru Shiraso
- Department of Surgery, Iwaki Kyoritsu General Hospital, Iwaki, Fukushima, Japan
| | | | - Toshiyasu Iwao
- Department of Gastroenterology, Aidu Chuo Hospital, Aizu Wakamatsu, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopedic Surgery, School Medicine, Fukushima Medical University, Fukushima, Japan
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Patel V, Patel S, Grossman S, Wali R, Burns M, Zebic L, Enting D, Henien M. The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 4: miscellaneous cancers. Br Dent J 2022; 232:213-218. [PMID: 35217738 DOI: 10.1038/s41415-022-3983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
This article discusses relevant information for the dental sector regarding metastatic cancers beyond breast and prostate cancer. Typically, tumour sites such as lung, renal, colorectal, gastrointestinal, thyroid, hepatic and pancreatic cancers are increasingly being referred for bone-targeting agents upon evidence of bone metastases.The current article explores the presenting dental status of these tumour groups on the background of survival outcomes. In addition, the article provides insight towards the complexity in achieving 'dental fitness' and whether 'dental stability' could be an alternative to consider via palliative dentistry in certain cases.
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Affiliation(s)
- Vinod Patel
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK.
| | - Sheelen Patel
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | | | - Rana Wali
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Megan Burns
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Lara Zebic
- Oral Surgery Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Deborah Enting
- Medical Oncology, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - Marianne Henien
- Department of Oral Surgery, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
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Sethakorn N, Heninger E, Sánchez-de-Diego C, Ding AB, Yada RC, Kerr SC, Kosoff D, Beebe DJ, Lang JM. Advancing Treatment of Bone Metastases through Novel Translational Approaches Targeting the Bone Microenvironment. Cancers (Basel) 2022; 14:757. [PMID: 35159026 PMCID: PMC8833657 DOI: 10.3390/cancers14030757] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Bone metastases represent a lethal condition that frequently occurs in solid tumors such as prostate, breast, lung, and renal cell carcinomas, and increase the risk of skeletal-related events (SREs) including pain, pathologic fractures, and spinal cord compression. This unique metastatic niche consists of a multicellular complex that cancer cells co-opt to engender bone remodeling, immune suppression, and stromal-mediated therapeutic resistance. This review comprehensively discusses clinical challenges of bone metastases, novel preclinical models of the bone and bone marrow microenviroment, and crucial signaling pathways active in bone homeostasis and metastatic niche. These studies establish the context to summarize the current state of investigational agents targeting BM, and approaches to improve BM-targeting therapies. Finally, we discuss opportunities to advance research in bone and bone marrow microenvironments by increasing complexity of humanized preclinical models and fostering interdisciplinary collaborations to translational research in this challenging metastatic niche.
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Affiliation(s)
- Nan Sethakorn
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Erika Heninger
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
| | - Cristina Sánchez-de-Diego
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Adeline B. Ding
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
| | - Ravi Chandra Yada
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Sheena C. Kerr
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - David Kosoff
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - David J. Beebe
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Joshua M. Lang
- University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (N.S.); (E.H.); (C.S.-d.-D.); (A.B.D.); (S.C.K.); (D.K.); (D.J.B.)
- Division of Hematology/Oncology, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
- Wisconsin Institutes for Medical Research, 1111 Highland Ave., Madison, WI 53705, USA
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21
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Park SJ, Park JS, Nam Y, Lee CS. Characteristics of Patients Undergoing Surgical Treatment for Spinal Metastases From Colorectal Cancer: A Comparison With Non-Small Cell Lung Cancer. Clin Spine Surg 2022; 35:E187-E193. [PMID: 34379609 DOI: 10.1097/bsd.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE This study aimed to investigate the prognosis and characteristics of patients undergoing surgical treatment for colorectal cancer (CRC) spinal metastasis. To better understand the characteristics of such patients, their results were compared with those with spinal metastasis from non-small cell lung cancer (NSCLC), as the prognosis of these patients is well-studied. SUMMARY OF BACKGROUND DATA CRC commonly metastasizes to the liver or lung, while spinal metastases occur infrequently. The literature contains very few studies evaluating the prognosis of patients with spinal metastases from CRC. MATERIALS AND METHODS A consecutive 155 patients who underwent surgical treatment for spinal metastases from CRC (n=35) or NSCLC (n=120) between 2010 and 2018 were included in this study. Data were collected throughout the disease course, including those concerning all cancer-related treatments for both the primary cancer and spinal metastasis. Categorical variables were divided into patient, tumor, and treatment factors, and postoperative survival times were compared between the CRC and NSCLC groups. RESULTS The mean interval from cancer diagnosis to spinal metastasis was significantly greater in CRC group (32.5 mo) than in NSCLC group (12.9 mo). Concurrent spinal metastasis was more common in NSCLC group than CRC group (45.0% vs. 17.2%; P=0.003). Visceral metastasis was found more frequently in CRC group than NSCLC group (77.1% vs. 42.5%; P<0.001). The proportion of patients undergoing postoperative systemic treatment was significantly higher in NSCLC group than CRC group (59.2% vs. 20.0%; P<0.001). Median survival time after spine surgery was 4.2 months in CRC group and 5.8 months in NSCLC group (P=0.015). CONCLUSIONS The prognosis after surgical treatment for CRC spinal metastasis was poor, and worse than that of NSCLC group. These results can be explained by the later development of spinal metastases and the limited chance of postoperative medical treatment in CRC spinal metastasis.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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22
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Byttner M, Wedin R, Bauer H, Tsagozis P. Outcome of surgical treatment for bone metastases caused by colorectal cancer. J Gastrointest Oncol 2021; 12:2150-2156. [PMID: 34790381 DOI: 10.21037/jgo-21-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions. Methods Retrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included. Results Most metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable. Conclusions Although relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high.
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Affiliation(s)
- Martina Byttner
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Rikard Wedin
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Bauer
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Panagiotis Tsagozis
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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23
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Sakisuka T, Kashiwagi N, Doi H, Takahashi H, Arisawa A, Matsuo C, Masuda Y, Inohara H, Sato K, Outani H, Ishii K, Tomiyama N. Prognostic factors for bone metastases from head and neck squamous cell carcinoma: A case series of 97 patients. Mol Clin Oncol 2021; 15:246. [PMID: 34650813 DOI: 10.3892/mco.2021.2408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Although bone is the second-most frequent site of distant metastases of head and neck squamous cell carcinoma (HNSCC), variable prognostic factors in patients with bone metastases from HNSCC have not been fully investigated. The aim of the present study was to assess the prognostic factors affecting overall survival (OS) in these patients. The medical records of 97 patients at two institutions who developed bone metastases from HNSCC between January 2010 and December 2020 were retrospectively reviewed. A multivariate analysis using a Cox proportional hazards model was performed to identify potential clinical predictive factors for longer OS. The median OS was 7 months, and the 1- and 2-year OS rates for all patients were 35.4 and 19.2%, respectively. The independent predictive factors for longer OS were single bone metastasis, good performance status and administration of systemic chemotherapy. The median OS with each predictor was 10, 10 and 10.5 months, respectively. In a selected group of patients with these three factors, the OS was 14.5 months. In conclusion, single bone metastasis, a good performance status and systemic chemotherapy were independent predictors of longer OS in patients with HNSCC, but their contributions were limited.
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Affiliation(s)
- Takahisa Sakisuka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Nobuo Kashiwagi
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Hiroto Takahashi
- Center for Twin Research, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Atsuko Arisawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Chisato Matsuo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yu Masuda
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kazuaki Sato
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hidetatsu Outani
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Hsu TL, Wu K. Colorectal cancer with first known case of simultaneous bilateral tibial metastases. J Int Med Res 2021; 49:3000605211027773. [PMID: 34308691 PMCID: PMC8320580 DOI: 10.1177/03000605211027773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The most common osseous metastatic regions for colorectal cancer are the lumbar and sacral vertebrae and the pelvis. There are few reported cases of isolated solitary tibial metastasis, and simultaneous bilateral solitary tibial metastases in colorectal cancer are even rarer. A 62-year-old female patient was admitted to our inpatient clinic 3 years after receiving initial chemotherapy for a rectosigmoid adenocarcinoma with liver metastasis. The patient complained of left leg pain. Radiographs and magnetic resonance imaging revealed a 3- × 3-cm mass in the right proximal tibia and a 2- × 7-cm mass in the middle third of the left tibia; both were highly suggestive of bone metastases. Bilateral tibial metastases were confirmed after tumor excision and prophylactic open reduction and internal fixation. The postoperative course was relatively uneventful. Colorectal cancer with bone metastases is uncommon, and most metastases are found at a single site in an extremity. We believe this is the first published case of simultaneous bilateral tibial metastases in a patient with colorectal cancer.
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Affiliation(s)
- Ta Li Hsu
- Department of Orthopedic Surgery, 46608Far Eastern Memorial Hospital, Far Eastern Memorial Hospital, New Taipei City
| | - Karl Wu
- Department of Orthopedic Surgery, 46608Far Eastern Memorial Hospital, Far Eastern Memorial Hospital, New Taipei City
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Kawamura R, Suzuki Y, Harada Y, Shimizu T. Atypical presentation of colorectal carcinoma with sole multiple osteolytic bone metastases: a case report. J Med Case Rep 2021; 15:256. [PMID: 34016176 PMCID: PMC8139034 DOI: 10.1186/s13256-021-02795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background The incidence of colorectal cancer in persons aged < 50 years has been increasing. The diagnosis of colorectal cancer is not difficult if the patient has typical symptoms; however, diagnosis may be difficult in cases with atypical symptoms and signs. We present here an atypical case of metastatic colorectal cancer with fever and sudden onset paraplegia as the sole manifestations. The patient had multiple osteolytic lesions without gastrointestinal symptoms or signs, which resulted in a diagnostic delay of colorectal cancer. Case presentation A 46-year-old Japanese man was transferred to our hospital for evaluation of fever. He had developed fever 8 weeks previously and had been first admitted to another hospital 5 weeks ago. The patient was initially placed on antibiotics based on the suspicion of a bacterial infection. During the hospital stay, the patient experienced a sudden onset of paralysis and numbness in his both legs. Magnetic resonance imaging showed an epidural mass at the level of Th11, and the patient underwent a laminectomy. Epidural abscess and vertebral osteomyelitis were suspected, and antimicrobial treatment was continued. However, his fever persisted, and he was transferred to our hospital. Chest, abdominal, and pelvic computed tomography (CT) with contrast showed diffusely distributed osteolytic lesions. Fluorodeoxyglucose-positron-emission tomography showed high fluorodeoxyglucose accumulation in multiple discrete bone structures; however, no significant accumulation was observed in the solid organs or lymph nodes. A CT-guided bone biopsy obtained from the left iliac bone confirmed the evidence of metastatic adenocarcinoma based on immunohistochemistry. A subsequent colonoscopy showed a Borrmann type II tumor in the sigmoid colon, which was confirmed to be a poorly differentiated adenocarcinoma. As a result of shared decision-making, the patient chose palliative care. Conclusions Although rare, osteolytic bone metastases as the sole manifestation can occur in patients with colorectal cancer. In patients with conditions difficult to diagnose, physicians should prioritize the necessary tests based on differential diagnoses by analytical clinical reasoning, taking into consideration the patients clinical manifestation and the disease epidemiology. Bone biopsies are usually needed in patients only with sole osteolytic bone lesions; however, other rapid and useful non-invasive diagnostic tests can be also useful for narrowing the differential diagnosis.
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Affiliation(s)
- Ren Kawamura
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Yudai Suzuki
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan.
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Chengling L, Yulin Z, Xiaoyu X, Xingchen L, Sen Z, Ziming W, Xianming C. miR-325-3p, a novel regulator of osteoclastogenesis in osteolysis of colorectal cancer through targeting S100A4. Mol Med 2021; 27:23. [PMID: 33691630 PMCID: PMC7944890 DOI: 10.1186/s10020-021-00282-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate effect of microRNA-325-3p (miR-325-3p) on bone metastasis of colorectal cancer (CRC) and the precise role on osteoclastogenesis. METHODS CT-26 cells were injected into tibias to establish bone metastatic model of CRC in vivo. AgomiR-325-3p or antagomir-325-3p were injected in tail-veins of Balb/c mice to interfere the osteoclastogenesis and bone metastasis of CRC. Safranin O and Fast Green staining examined the changes of trabecular area and TRAP staining examined the osteoclast number in bone metastasis of CRC. Real-time PCR was conducted to test the RNA level of miR-325-3p and mRNA levels of TRAP and Cathepsin K in osteoclast precursors (OCPs). Dual-luciferase reporter system was utilized to identify the direct target of miR-325-3p. Conditioned medium from CT-26 cells was collected to stimulate the OCPs during osteoclastogenesis induced by RANKL and M-CSF in vitro. Western blot analysis was performed to examine the protein level of S100A4 in OCPs after interfered by agomiR-325-3p or antagomir-325-3p cultured in CM or not. RESULTS miR-325-3p downregulated in OCPs in CRC microenvironment both in vivo and in vitro. By luciferase activity assay, S100A4 was the target gene of miR-325-3p and the protein level of S100A4 in OCPs upregulated in CRC microenvironment. Overexpression of miR-325-3p inhibited the osteoclastogenesis of OCPs and it can be reversed after transfection with plasmid containing S100A4. Treatment with miR-325-3p can preserve trabecular area in bone metastasis of CRC. CONCLUSION miR-325-3p can prevent osteoclast formation through targeting S100A4 in OCPs. Overexpression of miR-325-3p efficiently decreased the osteoclast number and attenuated bone resorption in bone metastasis of CRC.
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Affiliation(s)
- Li Chengling
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
| | - Zhang Yulin
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, 400030 People’s Republic of China
| | - Xie Xiaoyu
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
| | - Lu Xingchen
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
| | - Zhang Sen
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
| | - Wang Ziming
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
| | - Chen Xianming
- Daping Hospital of Army Medical University, Chongqing, 400042 People’s Republic of China
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Survival outcome and prognostic factors for colorectal cancer with synchronous bone metastasis: a population-based study. Clin Exp Metastasis 2021; 38:89-95. [PMID: 33420873 DOI: 10.1007/s10585-020-10069-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023]
Abstract
Prognostic factors of synchronous bone metastatic colorectal cancer (CRC) are still undetermined. We aimed to investigate survival outcome and prognostic factors of patients with synchronous bone metastatic CRC. Information of patients with synchronous bone metastatic CRC were obtained from the Surveillance, Epidemiology, and End Results (SEER) and West China Hospital (WCH) databases. Cases from SEER database composed construction cohort, while cases from WCH database were used as validation cohort. A novel nomogram was constructed to predict individual survival probability based on Cox regression model. The performance of the nomogram was internally and externally validated using calibration curves and concordance index (C-index). Three hundred and eighty-one patients from SEER database were eligible. The median disease specific OS was 9.0 months (95% confidence interval [CI]: 7.3-10.7 months). Multivariate Cox analysis identified seven independent prognostic factors including histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis. A novel nomogram was established based on these variables. In the internal validation, the C-index (0.72, 95% CI 0.69-0.75) and calibration curve indicated well performance of this nomogram at predicting survival outcome in bone metastatic CRC. In the external validation, the C-index was 0.57 (95% CI 0.46-0.68). The prognosis of synchronous bone metastatic CRC is very poor. Histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis are independent prognostic factors. Further study is warranted to confirm the practicality of the prognostic nomogram.
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Park HS, Chun YJ, Kim HS, Kim JH, Lee CK, Beom SH, Shin SJ, Ahn JB. Clinical features and KRAS mutation in colorectal cancer with bone metastasis. Sci Rep 2020; 10:21180. [PMID: 33273596 PMCID: PMC7713114 DOI: 10.1038/s41598-020-78253-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Bone metastasis is known as a poor prognostic factor in colorectal cancer (CRC), but its clinical manifestations and outcomes are uncertain. CRC with bone metastasis was searched from January 2006 to April 2016. Of 11,551 CRC patients, 321 (2.7%) patients had bone metastasis. Bone-only metastasis was found in only 8.7% of patients. Synchronous bone metastasis was present in 147 (45.8%) patients. In patients with metachronous bone metastasis, the median time from CRC diagnosis to bone metastasis (TTB) was 27.2 months. KRAS mutation status was a marginally significant factor affecting TTB (median TTB, KRAS wild-type or mutation: 29 or 25.8 months, respectively, P = 0.068). Skeletal-related events (SREs) were noted in 200 (62.3%) patients. Median overall survival (OS) from diagnosis of bone metastasis was 8.0 months. On multivariate analysis, multi-organ metastasis, peritoneal metastasis, neutrophil-to-lymphocyte ratio (NLR) ≥ 2.7, and alkaline phosphatase (ALP) ≥ 123 were independent factors for OS. Palliative chemotherapy prolonged survival in CRC patients with bone metastasis (HR 0.25, 95% CI 0.2–0.33). In conclusion, bone metastasis of CRC is rare, but it is related to SREs. Most patients have other organ metastasis and survival is 8.0 months. Attention should be paid to bone metastasis in CRC patients.
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Affiliation(s)
- Hyung Soon Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - You Jin Chun
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Hung Kim
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Joharatnam-Hogan N, Wilson W, Shiu KK, Fusai GK, Davidson B, Hochhauser D, Bridgewater J, Khan K. Multimodal Treatment in Metastatic Colorectal Cancer (mCRC) Improves Outcomes-The University College London Hospital (UCLH) Experience. Cancers (Basel) 2020; 12:cancers12123545. [PMID: 33261002 PMCID: PMC7760146 DOI: 10.3390/cancers12123545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite notable advances in the management of metastatic colorectal cancer (mCRC) over the last two decades, treatment intent in the vast majority of patients remains palliative due to technically unresectable disease, extensive disease, or co-morbidities precluding major surgery. Up to 30% of individuals with mCRC are considered potentially suitable for primary or metastasis-directed multimodal therapy, including surgical resection, ablative techniques, or stereotactic radiotherapy (RT), with the aim of improving survival outcomes. We reviewed the potential benefits of multimodal therapy on the survival of patients with mCRC treated at the UCLH. METHODS Clinical data on baseline characteristics, multimodal treatments, and survival outcomes were retrospectively collected from all patients with mCRC receiving systemic chemotherapy between January 2013 and April 2017. Primary outcome was the impact of multimodal therapy on overall survival, compared to systemic therapy alone, and the effect of different types of multimodal therapy on survival outcome, and was assessed using the Kaplan-Meier approach. All analyses were adjusted for age, gender, and side of primary tumour. RESULTS One-hundred and twenty-five patients with mCRC were treated during the study period (median age: 62 years (range 19-89). The liver was the most frequent metastatic site (78%; 97/125). A total of 52% (65/125) had ≥2 lines of systemic chemotherapy. Of the 125 patients having systemic chemotherapy, 74 (59%) underwent multimodal treatment to the primary tumour or metastasis. Median overall survival (OS) was 25.7 months [95% Confidence Interval (CI) 21.5-29.0], and 3-year survival, 26%. Univariate analysis demonstrated that patients who had additional procedures (surgery/ablation/RT) were significantly less likely to die (Hazard Ratio (HR) 0.18, 95% CI 0.12-0.29, p < 0.0001) compared to those receiving systemic chemotherapy alone. Increasing number of multimodal procedures was associated with an incremental increase in survival-with median OS 28.4 m, 35.7 m, and 64.8 m, respectively, for 1, 2, or ≥3 procedures (log-rank p < 0.0001). After exclusion of those who received systemic chemotherapy only (n = 51), metastatic resections were associated with improved survival (adjusted HR 0.36, 95% CI 0.20-0.63, p < 0.0001), confirmed in multivariate analysis. Multiple single-organ procedures did not improve survival. CONCLUSION Multimodal therapy for metastatic bowel cancer is associated with significant survival benefit. Resection/radical RT of the primary and resection of metastatic disease should be considered to improve survival outcomes following multidisciplinary team (MDT) discussion and individual assessment of fitness.
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Affiliation(s)
- Nalinie Joharatnam-Hogan
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - William Wilson
- Department of Statistics, Cancer Research UK and UCL Cancer Trials Centre, London W1T 4TJ, UK;
| | - Kai Keen Shiu
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - Giuseppe Kito Fusai
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London NW13 1QG, UK; (G.K.F.); (B.D.)
| | - Brian Davidson
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London NW13 1QG, UK; (G.K.F.); (B.D.)
| | - Daniel Hochhauser
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - John Bridgewater
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - Khurum Khan
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
- Research Department of Oncology, UCL Cancer Institute, London WC1E 6BT, UK
- Department of Medical Oncology, North Middlesex University Hospital, London N18 1QX, UK
- Department of Oncology, GI Cancer Lead North London & Oncology Research Lead North Middlesex University Hospital, London N18 1QX, UK
- Correspondence: or
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Bianchi A, Jimenez-Segovia M, Bonnin-Pascual J, Gamundí-Cuesta M, Fernandez-Isart M, Guillot-Morales M, Salinas-Gonzalez D, Gonzalez-Argenté XF. Aberrant single metastasis to the elbow from primary rectal cancer: a rare presentation. Pan Afr Med J 2020; 36:383. [PMID: 33235660 PMCID: PMC7666695 DOI: 10.11604/pamj.2020.36.383.21634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/14/2020] [Indexed: 11/28/2022] Open
Abstract
Rectal adenocarcinoma usually metastasizes to the liver and lungs and when it has bone spread, it more frequently involves the vertebrae and pelvis. Thus, aberrant metastasis from a rectal adenocarcinoma to upper extremities with preservation of intra-abdominal organs is very uncommon. We present the case of an 80-year-old male patient with a diagnosis of adenocarcinoma of the rectum T4N1M1 with non-axial single bone metastases and with preservation of visceral organs. Anterior resection of rectum after neoadjuvant chemotherapy and radiotherapy were made. The bone metastasis received palliative radiotherapy and was not resected. The patient died 10 months after diagnosis. This clinical situation generally has a poor prognosis. When the patient complains of unusual bone pain it is necessary to suspect a malignant disease and even if extraordinarily rare, rectal cancer must be considered as a possible cause.
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Affiliation(s)
- Alessandro Bianchi
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Marina Jimenez-Segovia
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jaume Bonnin-Pascual
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Marga Gamundí-Cuesta
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Myriam Fernandez-Isart
- Department of General Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Diego Salinas-Gonzalez
- Department of Traumatology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Asiry S, Matloob A, Gera S. When accurate cytomorphology directs clinical decision: Colonic adenocarcinoma presents initially with an isolated vertebral bone metastasis. Diagn Cytopathol 2020; 48:1325-1327. [PMID: 32816398 DOI: 10.1002/dc.24590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022]
Abstract
Liver is the most common site for metastasis of colonic adenocarcinoma. Other relatively common metastatic locations include: peritoneum, lungs and ovaries. Rare metastatic sites include: central nervous system, testis, uterus, oral cavity and bones. Though it is rare to have an isolated bone metastasis without liver or visceral involvement in colonic adenocarcinoma, it can occur. Our case illustrates the vital role of an accurate cytopathologic diagnosis in directing the proper clinical decision and management in our young patient. Our patient's first presentation was acute on chronic back pain radiating to his lower extremities with clinical suspicion of tuberculosis spondylitis. The correct cytopathologic diagnosis of the fine needle aspiration from the destructive vertebral lesion led to the establishment of an isolated metastatic colonic adenocarcinoma diagnosis initially and directed the clinical management of our patient.
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Affiliation(s)
- Saeed Asiry
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Ammar Matloob
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Shweta Gera
- The Leopold G. Koss Division of Cytopathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
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Li CL, Tang DR, Ji J, Zang B, Chen C, Zhao JQ. Colorectal adenocarcinoma patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases: A propensity score matching analysis. World J Clin Cases 2020; 8:3230-3239. [PMID: 32874977 PMCID: PMC7441271 DOI: 10.12998/wjcc.v8.i15.3230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/25/2020] [Accepted: 06/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer (CRC). The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms. However, accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.
AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA (M1a diseases) and stage IVB (M1b diseases) colorectal adenocarcinoma (CRA).
METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results (SEER) database. To minimize potential selection bias, the data were adjusted by propensity score matching (PSM). Baseline characteristics, including gender, year of diagnosis, age, marital status, primary site, surgical information, race, grade, chemotherapy, and radiotherapy, were recorded and analyzed. Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.
RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database, including 10399 cases of M1a diseases and 9281 cases of M1b diseases. Common independent prognostic factors for both M1a and M1b patients included year of diagnosis, age, race, marital status, primary site, grade, surgery, and chemotherapy. After PSM adjustment, 3732 and 3568 matched patients in the M1a and M1b groups were included, respectively. Patients receiving palliative primary tumor resection had longer survival time than those without surgery (P < 0.001). For patients with M1a diseases, palliative resection could increase the median survival time by 9 mo; for patients with M1b diseases, palliative resection could prolong the median survival time by 7 mo. For M1a diseases, patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis (15 mo for lung metastasis vs 8 mo for liver metastasis, P < 0.001).
CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases. Those patients with M1a (lung metastasis) have superior long-term outcomes after palliative primary tumor resection.
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Affiliation(s)
- Cheng-Lin Li
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - De-Rong Tang
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - Jian Ji
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - Bao Zang
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - Chen Chen
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
| | - Jian-Qiang Zhao
- Department of Thoracic Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
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Colorectal Cancer and Bone Tissue: Fantastic Relations and Where to Find Them. Cancers (Basel) 2020; 12:cancers12082029. [PMID: 32722068 PMCID: PMC7464482 DOI: 10.3390/cancers12082029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. There is a need for the early diagnosis of CRC for a better prognostic outcome. It is, therefore, crucial to understand the CRC pathogenesis in all its aspects. In many cases, one of the main causes of cancer-related deaths is the presence of metastases. In this context, an often overlooked aspect is the metastatic tropism, since CRC, like other cancers, is more prone to metastasize some organs rather than others. Beyond the liver and lung, and differently from other types of cancers, a not usual site of CRC metastases is the bone. However, it may assume a crucial role in the development and the outcome of the disease. Therefore, this review aims to discuss the complex relations between bone markers and CRC pathogenesis, suggesting the use of these molecules as potential targets for therapeutic purposes. Different osteogenic molecules, some of whom are growth factors and are implicated in the different osteogenic pathways, have been proved to also be involved in CRC progression. Some of them are oncogenes, while others oncosuppressors, and in a future perspective, some of them may represent new potential CRC biomarkers.
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Hong S, Youk T, Lee SJ, Kim KM, Vajdic CM. Bone metastasis and skeletal-related events in patients with solid cancer: A Korean nationwide health insurance database study. PLoS One 2020; 15:e0234927. [PMID: 32678818 PMCID: PMC7367479 DOI: 10.1371/journal.pone.0234927] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
Bone is one of the most common sites of metastasis from advanced solid tumors. Bone metastasis is a leading cause of pain and increases the risk of skeletal-related events (SREs) in cancer patients. In addition to affecting the quality of life, it also increases the medical costs and mortality risk. We aimed to examine the occurrence of bone metastasis and SREs in Korean cancer patients using a nationwide health database. Using claims data from the National Health Insurance Service-National Sample Cohort (2002–2013), we extracted the data of bone metastasis patients diagnosed with any of the seven major cancers in Korea from January 2002 to December 2010. Selected SREs included pathologic fracture, spinal cord compression, radiation therapy, and palliative bone surgery. We used time-to-event analysis to estimate patient survival after bone metastasis. A total of 21,562 newly diagnosed cancer patients were identified; bone metastases developed in 1,849 patients (breast cancer, 18.8%; prostate cancer, 17.5%; lung cancer, 13.7%). The median time from primary cancer diagnosis to bone metastasis was 18.9 months. The cumulative incidence of SREs was 45.1% in all bone metastasis patients. The most common cancer type was lung cancer (53.4%), followed by liver (50.9%), prostate (45.9%), breast (43.6%), and colorectal (40.2%) cancers. Almost all SREs developed 1 month after bone metastasis, except in patients with breast and prostate cancers (median: 5.9 months in breast cancer and 4.7 months in prostate cancer). Survival duration after the development of bone metastasis was < 6 months in stomach, liver, colorectal, and lung cancer patients. Breast and prostate cancer patients survived for > 1 year after the occurrence of SREs. This study reveals the epidemiology of bone metastasis and SREs in Korean cancer patients, and the findings can be used to assess the actual bone health status of cancer patients.
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Affiliation(s)
- Soojung Hong
- Division of Oncology-hematology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- * E-mail: ,
| | - Taemi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Su Jin Lee
- Department of internal medicine, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - Kyoung Min Kim
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States of America
| | - Claire M. Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Ma CX, Guan X, Wei R, Wang S, Quan JC, Zhao ZX, Chen HP, Liu Z, Jiang Z, Wang XS. The Distinction of Clinicopathological Characteristics, Treatment Strategy and Outcome in Colorectal Cancer Patients With Synchronous vs. Metachronous Bone Metastasis. Front Oncol 2020; 10:974. [PMID: 32637357 PMCID: PMC7318073 DOI: 10.3389/fonc.2020.00974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background: The impact of the timing of bone metastasis (BM) diagnosis on colorectal cancer (CRC) patients is unclear. Our study aimed to explore the differences in clinicopathological characteristics, treatments and prognosis between synchronous BM (SBM) and metachronous BM (MBM) from CRC. Methods: We retrospectively investigated clinical data of CRC patients with SBM or MBM from 2008 to 2017 at Chinese National Cancer Center. Cancer specific survival (CSS) after BM diagnosis was estimated using the Kaplan-Meier method. The multivariable COX regression model identified the prognostic factors of CSS. Results: Finally, 63 CRC patients with SBM and 138 CRC patients with MBM were identified. Compared to SBM from CRC, MBM significantly was more involving multiple bone lesions (63.0 vs. 7.9%; p < 0.001), and more frequently originated from rectal cancer (60.9 vs. 41.3%; p = 0.033). The therapeutic strategies in SBM and MBM group were contrasted including systemic treatment, bisphosphonates, radiotherapy and metastasectomy for BM. 85.5% of patients in MBM group and 25.4% of patients in SBM group underwent primary tumor resection at initial diagnosis (p < 0.001). The median CSS was 11 months in both SBM and MBM group (p = 0.556), yet MBM patients developed from CRC in early AJCC stage presented obviously longer survival than those from advanced stage. Furthermore, patients could have improved CSS from primary tumor resection while there might be no survival benefit from targeted therapy in both SBM and MBM groups. Bisphosphonates was associated with a better CSS for patients with SBM, while radiotherapy for BM was related to a better CSS for patients with MBM. Conclusion: The CRC patients in SBM and MBM group represented different clinicopathological characteristics and treatment modalities, which affected the prognosis in different ways. Distinct consideration for CRC patients with SBM and MBM in clinical decision making is required.
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Affiliation(s)
- Chen-Xi Ma
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Ran Wei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Song Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ji-Chuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zhi-Xun Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Hai-Peng Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
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Akahane K, Shirai K, Wakatsuki M, Ogawa K, Minato K, Hamamoto K, Takahashi S, Suzuki K, Takahashi J, Rikiyama T, Matsumoto K, Mashima H. Severe esophageal stenosis in a patient with metastatic colon cancer following palliative radiotherapy, ramucirumab, and chemotherapy. Clin Case Rep 2020; 8:919-922. [PMID: 32477545 PMCID: PMC7250969 DOI: 10.1002/ccr3.2751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022] Open
Abstract
Antiangiogenic agents, such as ramucirumab, should be cautiously administered along with radiotherapy because of the enhanced risk of adverse events.
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Affiliation(s)
- Keiko Akahane
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Katsuyuki Shirai
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | | | - Kazunari Ogawa
- Department of RadiologyJichi Medical UniversityShimotsukeJapan
| | - Kyosuke Minato
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Kohei Hamamoto
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | | | - Koichi Suzuki
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Jun Takahashi
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Toshiki Rikiyama
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Keita Matsumoto
- Department of GastroenterologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Hirosato Mashima
- Department of GastroenterologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
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37
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Maroni P. Leptin, Adiponectin, and Sam68 in Bone Metastasis from Breast Cancer. Int J Mol Sci 2020; 21:ijms21031051. [PMID: 32033341 PMCID: PMC7037668 DOI: 10.3390/ijms21031051] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
The most serious aspect of neoplastic disease is the spread of cancer cells to secondary sites. Skeletal metastases can escape detection long after treatment of the primary tumour and follow-up. Bone tissue is a breeding ground for many types of cancer cells, especially those derived from the breast, prostate, and lung. Despite advances in diagnosis and therapeutic strategies, bone metastases still have a profound impact on quality of life and survival and are often responsible for the fatal outcome of the disease. Bone and the bone marrow environment contain a wide variety of cells. No longer considered a passive filler, bone marrow adipocytes have emerged as critical contributors to cancer progression. Released by adipocytes, adipokines are soluble factors with hormone-like functions and are currently believed to affect tumour development. Src-associated in mitosis of 68 kDa (Sam68), originally discovered as a protein physically associated with and phosphorylated by c-Src during mitosis, is now recognised as an important RNA-binding protein linked to tumour onset and progression of disease. Sam68 also regulates splicing events and recent evidence reports that dysregulation of these events is a key step in neoplastic transformation and tumour progression. The present review reports recent findings on adipokines and Sam68 and their role in breast cancer progression and metastasis.
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Affiliation(s)
- Paola Maroni
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milano, Italy
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38
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Argentiero A, Calabrese A, Solimando AG, Notaristefano A, Panarelli MM, Brunetti O. Bone metastasis as primary presentation of pancreatic ductal adenocarcinoma: A case report and literature review. Clin Case Rep 2019; 7:1972-1976. [PMID: 31624620 PMCID: PMC6787833 DOI: 10.1002/ccr3.2412] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022] Open
Abstract
PDAC bone metastases represent a clinical challenge characterized by multifaceted biological entity.
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Affiliation(s)
- Antonella Argentiero
- Medical Oncology UnitNational Cancer Research CentreIstituto Tumori "Giovanni Paolo II"BariItaly
| | - Angela Calabrese
- Radiology UnitNational Cancer Research CentreIstituto Tumori "Giovanni Paolo II"BariItaly
| | - Antonio Giovanni Solimando
- Medical Oncology UnitNational Cancer Research CentreIstituto Tumori "Giovanni Paolo II"BariItaly
- Department of Biomedical Sciences and Human OncologySection of Internal Medicine “G. Baccelli”University of Bari Medical SchoolBariItaly
| | | | | | - Oronzo Brunetti
- Medical Oncology UnitNational Cancer Research CentreIstituto Tumori "Giovanni Paolo II"BariItaly
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Skeletal Metastases of Unknown Primary: Biological Landscape and Clinical Overview. Cancers (Basel) 2019; 11:cancers11091270. [PMID: 31470608 PMCID: PMC6770264 DOI: 10.3390/cancers11091270] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Skeletal metastases of unknown primary (SMUP) represent a clinical challenge in dealing with patients diagnosed with bone metastases. Management of these patients has improved significantly in the past few years. however, it is fraught with a lack of evidence. While some patients have achieved impressive gains, a more systematic and tailored treatment is required. Nevertheless, in real-life practice, the outlook at the beginning of treatment for SMUP is decidedly somber. An incomplete translational relevance of pathological and clinical data on the mortality and morbidity rate has had unsatisfactory consequences for SMUP patients and their physicians. We examined several approaches to confront the available evidence; three key points emerged. The characterization of the SMUP biological profile is essential to driving clinical decisions by integrating genetic and molecular profiles into a multi-step diagnostic work-up. Nonetheless, a pragmatic investigation plan and therapy of SMUP cannot follow a single template; it must be adapted to different pathophysiological dynamics and coordinated with efforts of a systematic algorithm and high-quality data derived from statistically powered clinical trials. The discussion in this review points out that greater efforts are required to face the unmet needs present in SMUP patients in oncology.
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40
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Nanotechnology is an important strategy for combinational innovative chemo-immunotherapies against colorectal cancer. J Control Release 2019; 307:108-138. [DOI: 10.1016/j.jconrel.2019.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
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Berruti A, Libè R, Laganà M, Ettaieb H, Sukkari MA, Bertherat J, Feelders RA, Grisanti S, Cartry J, Mazziotti G, Sigala S, Baudin E, Haak H, Habra MA, Terzolo M. Morbidity and mortality of bone metastases in advanced adrenocortical carcinoma: a multicenter retrospective study. Eur J Endocrinol 2019; 180:311-320. [PMID: 30970324 DOI: 10.1530/eje-19-0026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/21/2019] [Indexed: 01/04/2023]
Abstract
Introduction Adrenocortical carcinoma (ACC) is a rare cancer that commonly spreads to the liver, lungs and lymph nodes. Bone metastases are infrequent. Objective The aim of this report was to describe the clinical characteristics, survival perspective, prognostic factors and frequency of adverse skeletal-related events (SREs) in patients with ACC who developed bone metastasis. Methods This is a retrospective, observational, multicenter, multinational study of patients diagnosed with bone metastases from ACC who were treated and followed up in three European countries (France, Italy and The Netherlands) and one center in the United States. Results Data of 156 patients were captured. The median overall survival was 11 months. SREs occurred in 47% of patients: 17% bone fractures, 17% spinal cord compression, 1% hypercalcemia, 12% developed more than one SRE. In multivariate analysis, cortisol hypersecretion was the only prognostic factor significantly associated with a higher mortality risk (hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.19-4.23, P = 0.013) and with the development of a SREs (of border line significance). The administration of antiresorptive therapies (bisphosphonates and denosumab) was associated with a lower risk of death, even if not significant, and their survival benefit appeared confined in patients attaining serum mitotane levels within the therapeutic range. Conclusion Bone metastases in ACC patients are associated with poor prognosis and high risk of SREs. Cortisol hypersecretion was the only prognostic factor suggesting a potential benefit from antisecretory medications. The therapeutic role of bisphosphonates and denosumab to improve patient outcome deserves to be tested in a prospective clinical trial.
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Affiliation(s)
- Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Rossella Libè
- Department of Endocrinology and Metabolic Diseases, Hôpital Cochin, Paris, France
| | - Marta Laganà
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Hester Ettaieb
- Department of Internal Medicine, Maxima Medisch Centrum Eindhoven/Veldhoven, Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Jérôme Bertherat
- Department of Endocrinology and Metabolic Diseases, Hôpital Cochin, Paris, France
| | - Richard A Feelders
- Erasmus Medical Center, Department of Internal Medicine, Academic Expertise Center for Adrenal and Neuroendocrine Tumors, Rotterdam, the Netherlands
| | - Salvatore Grisanti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Jérôme Cartry
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Gherardo Mazziotti
- Department of Biomedical Sciences Humanitas University and Endocrine and Andrology Unit, Humanitas Clinical and Research, Milan, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Harm Haak
- Department of Internal Medicine, Maxima Medisch Centrum Eindhoven/Veldhoven, Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | | | - Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
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Guo X, Zhang C, Ma W, Tian F, Xu G, Han X, Sun P, Baklaushev VP, Bryukhovetskiy AS, Wang G, Ma Y, Wang X. Patterns of bone metastases in newly diagnosed colorectal cancer: a real-world analysis in the SEER database. Int J Colorectal Dis 2019; 34:533-543. [PMID: 30617414 DOI: 10.1007/s00384-018-3213-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the incidence and the associated factors for bone metastases (BM) development and prognosis in initial colorectal cancer (CRC) with a large sample using Surveillance, Epidemiology, and End Results (SEER) cohort. METHODS Primary CRC patients, who were initially diagnosed between 2010 and 2015 in the SEER database, were included to analyze BM incidence and risk factors for BM occurrence. The patients with at least 1-year follow-up were involved to investigate the prognostic factors for BM. Multivariable logistic and proportional hazard regression models were used to investigate the risk factors for BM development and prognosis, respectively. RESULTS A total of 212,787 eligible CRC patients were included and 2557 of them were diagnosed with de novo BM (1.20%). Rectal cancer presented significantly higher BM incidence than right and left colon cancer (χ2 = 107.64, P < 0.001). T1 stage, poor differentiated grade, and brain metastases were homogeneously associated factors for BM development and BM patients' survival. Male gender, higher N stage, rectal site, elevated carcinoembryonic antigen, and lung and liver metastases were positively associated with BM occurrence. Older age, unmarried status, right colon site, and non-surgery were found to positively correlate with the death risk of CRC patients with BM. CONCLUSIONS BM is rare in CRC patients. Homogeneous and heterogeneous factors were found for BM development and BM patients' survival. The risk factors and prognostic factors can be used for BM screening and patient's prognosis estimation.
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Affiliation(s)
- Xu Guo
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China.,Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China
| | - Wenjuan Ma
- Department of Breast Imaging, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Fei Tian
- Department of colorectal cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China
| | - Xiuxin Han
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China
| | - Peng Sun
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University Harbin, China, Harbin, China.,Department of Colorectal Surgery, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Vladimir P Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Andrey S Bryukhovetskiy
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China
| | - Yulin Ma
- Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, China.
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China.
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Anorectal Cancer with Bone Marrow and Leptomeningeal Metastases. Case Rep Oncol Med 2019; 2018:9246139. [PMID: 30693122 PMCID: PMC6332972 DOI: 10.1155/2018/9246139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022] Open
Abstract
This is an interesting case of anorectal signet ring carcinoma with first presentation of an early stage disease, showing the aggressive disease and the undetectable behavior of this type of histology which can mislead diagnosis. Brain/CNS metastasis from colorectal cancer (CRC) is rare occurring in 3% of cases, and leptomeningeal carcinomatosis (LMC) is extremely rare in CRC (<0.02%). Symptoms and signs of LMC are pleomorphic and may be localized to three compartments: cerebral hemispheres, cranial nerves, and spinal cords and roots. Treatment of metastatic rectal cancer has been improving over the last few years with a lot of changes toward longer survival and improvement in quality of life and to change the disease into a chronic condition. However, in our case, the overall survival from the onset of LMC was 3 weeks only. Revising the evidence in the treatment of signet ring histology of rectal cancer, there is no specific treatment recommendation that is for this histology and for such very aggressive behavior which could be considered as a separate entity to the classic adenocarcinoma histology.
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Liu Y, Yang M, Li B, Xu K, Gao X, Li J, Wei H, Huang Q, Xu W, Xiao J. Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1491-1501. [DOI: 10.1007/s00586-019-05879-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/06/2019] [Indexed: 01/05/2023]
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Abstract
This retrospective analysis aim to evaluate the potential risk factors for bone metastases (BM) in patients who were diagnosed with colorectal cancer (CRC).A total of 2790 patients diagnosed with CRC between January 2006 and December 2016 were collected in this study. All patients were divided into 2 groups, BM and no BM. The associations between biomarkers (including age, gender, histopathological types, alkaline phosphatase (ALP), carcinoembryonic antigen (CEA), cancer antigen 125, and so on), and BM in patients with CRC were analyzed. All the analyses were conducted by SPSS software (version 22.0, SPSS, Chicago, IL).Of all patients, 74 (2.7%) were identified with BM. The level of serum ALP, CEA, and cancer antigen 125 in patients with BM were obviously higher than those without BM (P < .001, P = .005, and P < .001). And the cut-off values of ALP, CEA, and cancer antigen 125 were 85.5 U/L, 6.9 mmol/L, and 16.8 mmol/L, respectively.ALP, CEA, and cancer antigen 125 were identified as the independent risk factors for BM in patients with CRC.
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46
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Christensen TD, Jensen SG, Larsen FO, Nielsen DL. Systematic review: Incidence, risk factors, survival and treatment of bone metastases from colorectal cancer. J Bone Oncol 2018; 13:97-105. [PMID: 30591863 PMCID: PMC6303484 DOI: 10.1016/j.jbo.2018.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Background Bones are not considered a frequent metastatic site in patients with colorectal cancer (CRC). The purpose of the present study was to determine the incidence of bone metastases (BM) in CRC, to identify possible risk factors for BM, survival after BM, and effect of treatment of BM including antiresorptive treatment. Material and methods A computer-based literature search was carried out using PubMed and EMBASE. Results We included 29 studies. One randomized placebo controlled trial (RCT) study, two autopsy studies, five register studies, and twenty retrospective cohort studies. The studies described different cohorts making direct comparison difficult. Three studies analysed the effect of different treatments for BM including one RCT study. Conclusion The incidence of bone metastases was 3–7% in patients with CRC, and it was not possible to detect an increase in incidence over time. The most well established risk factors for BM are rectal cancer, having lymph node invasion at surgery of primary tumor, and lung metastases at any time. Other risk factors such as RAS mutation status have been suggested but results are not conclusive. Survival ranges from 5 to 21 months after diagnosis of BM depending on cohort, with survival of about 8 months in unselected patients. Several variables have been suggested as potential prognostic markers but are all poorly investigated. Treatment of BM is not well investigated, though patients seem to benefit from bisphosphonate treatment with regard to lower risk of skeletal related events. This review highlights the need for new research in the area.
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Salim X, D'Alessandro P, Little J, Mudhar K, Murray K, Carey Smith R, Yates P. A novel scoring system to guide prognosis in patients with pathological fractures. J Orthop Surg Res 2018; 13:228. [PMID: 30189869 PMCID: PMC6127912 DOI: 10.1186/s13018-018-0931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background The most appropriate treatment of pathological fractures from metastatic disease depends on several factors, one of the most important being predicted life expectancy. The aim of this study was to identify the variables that influence prognosis and utilise these to develop a novel scoring system to better predict life expectancy post-pathological fracture. Methods The records of all patients that presented with metastatic pathological fractures over a 10-year period from the only tertiary orthopaedic departments in Western Australia were retrospectively examined. Variables assessed were primary cancer type, fracture site, fixation method, cement augmentation, pre-morbid level of physical functioning, complication rate, treatment with chemotherapy or radiotherapy and appendicular, spinal and visceral metastatic load. Results A total of 233 patients were included. Median survival from fracture to death was 4.1 months. Median time from cancer diagnosis to pathological fracture was 14.2 months. There was a statistically significant association between patient survival and primary cancer type, physical functional score, spinal metastatic burden and use of chemotherapy or radiotherapy. Conclusion A novel scoring system has been developed that offers a survival probability based on patient’s individual circumstances. This can guide specialist management and offer patients a more accurate expectation of functional outcome and survival time.
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Affiliation(s)
- Xiang Salim
- Department of Orthopaedics, Sir Charles Gairdner Hospital, 55 Viewway Nedlands, Perth, WA, 6009, Australia.
| | - Peter D'Alessandro
- Department of Orthopaedics, Fiona Stanley Fremantle Hospital Groups, Perth, Australia.,Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - James Little
- Department of Orthopaedics, Fiona Stanley Fremantle Hospital Groups, Perth, Australia
| | - Kulvir Mudhar
- Department of Orthopaedics, Royal Perth Hospital, Perth, Australia
| | - Kevin Murray
- Centre for Applied Statistics, University of Western Australia, Perth, Australia
| | - Richard Carey Smith
- Department of Orthopaedics, Sir Charles Gairdner Hospital, 55 Viewway Nedlands, Perth, WA, 6009, Australia
| | - Piers Yates
- Department of Orthopaedics, Fiona Stanley Fremantle Hospital Groups, Perth, Australia.,Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
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Santini D, Brandi G, Aprile G, Russano M, Cereda S, Leone F, Lonardi S, Fornaro L, Scartozzi M, Silvestris N, Barni S, Pantano F, Vincenzi B, Palloni A, Frega G, Casagrande M, Ferrari L, Dadduzio V, Intini R, Filippi R, Vasile E, Vivaldi C, Faloppi L, Brunetti O, Reni M, Aglietta M, Tonini G. Bone metastases in biliary cancers: A multicenter retrospective survey. J Bone Oncol 2018; 12:33-37. [PMID: 30042924 PMCID: PMC6054714 DOI: 10.1016/j.jbo.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 10/24/2022] Open
Abstract
•Natural history of biliary cancers metastatic to bone•The role of skeletal events in patients with biliary cancer•Biliary cancer and bone metastases: role of bisphosphonates.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - G Brandi
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Aprile
- Department of Oncology, San Bortolo Hospital, ULSS8 Berica–East District, Vicenza, Italy
- Department of Oncology, University and General Hospital, Udine, Italy
| | - M Russano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - S Cereda
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - F Leone
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - L Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - M Scartozzi
- Medical Oncology, Hospital & University of Cagliari, Italy
| | - N Silvestris
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - S Barni
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047 Treviglio, Bergamo, Italy
| | - F Pantano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - B Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - A Palloni
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Frega
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Casagrande
- Department of Oncology, University and General Hospital, Udine, Italy
| | - L Ferrari
- Department of Oncology, University and General Hospital, Udine, Italy
| | - V Dadduzio
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Intini
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Filippi
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - E Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - C Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - L Faloppi
- Medical Oncology, Hospital of Macerata, Macerata, Italy & Medical Oncology, University of Cagliari, Italy
| | - O Brunetti
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - M Reni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - M Aglietta
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - G Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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49
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Affiliation(s)
- Aleksander Mika
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
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50
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Gaitanidis A, Alevizakos M, Tsaroucha A, Tsalikidis C, Pitiakoudis M. Predictive Nomograms for Synchronous Distant Metastasis in Rectal Cancer. J Gastrointest Surg 2018; 22:1268-1276. [PMID: 29663304 DOI: 10.1007/s11605-018-3767-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/28/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nomograms may be used to quantitatively assess the probability of synchronous distant metastasis. The purpose of this study is to develop predictive nomograms for the presence of synchronous distant metastasis in patients with rectal cancer. METHODS A retrospective analysis of the Surveillance Epidemiology and End Results database was performed for cases diagnosed between 2010 and 2014. RESULTS Overall, 46,785 patients with rectal cancer (27,773 [59.4%] males, mean age 63.9 ± 13.7 years) were identified, of which 6192 (13.2%) had liver metastasis, 2767 (5.9%) had lung metastasis, and 601 (1.3%) had bone metastasis. Age, sex, race, tumor location, tumor grade, primary tumor size, CEA levels, perineural invasion, T stage, N stage, and liver and lung metastasis were found to be associated with the presence of synchronous distant metastasis and were included in the predictive models. The c-indexes of these models were 0.99 for liver metastasis, 0.99 for lung metastasis, and 1 for bone metastasis. CONCLUSIONS Predictive nomograms for the presence of synchronous liver, lung, and bone metastasis were developed and may be used to predict the probability of distant disease in rectal cancer patients.
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Affiliation(s)
- Apostolos Gaitanidis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 681 00, Alexandroupoli, Greece.
| | - Michail Alevizakos
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandra Tsaroucha
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 681 00, Alexandroupoli, Greece
| | - Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 681 00, Alexandroupoli, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, 681 00, Alexandroupoli, Greece
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