Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and...Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal.We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day.Our sources included published citation network analyses,the documented proposal for randomised trials,large systematic reviews,and meta-analysis of observational studies.The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done,or having been done,were not reported.Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias.Randomised controlled trials(RCTs)are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice.One such trial is recruiting and shows that controlled trial are possible.展开更多
Colorectal cancer(CRC)is one of the most common cancers worldwide,with 5%-15%of CRC patients eventually developing lung metastasis(LM).Despite doubts about the role of locoregional therapy in the management of systemi...Colorectal cancer(CRC)is one of the most common cancers worldwide,with 5%-15%of CRC patients eventually developing lung metastasis(LM).Despite doubts about the role of locoregional therapy in the management of systemic disease,many surgeons have performed pulmonary metastasectomy(PM)for CRC in properly selected patients.However,the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies.This article reviews the results of surgical treatment of pulmonary metastases for CRC,focusing on(1)current treatment guidelines and surgical techniques of PM in patients with LM from CRC;(2)outcomes of PM and its prognostic factors;and(3)controversial issues in PM,focusing on repeated metastasectomy,bilateral multiple metas-tases,and combined liver and lung metastasectomy.展开更多
AIM： To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors. METHODS： Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observatio...AIM： To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors. METHODS： Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observation period was terminated on May 31, 2007. The surgical outcomes and the clinicopathological factors were compared. RESULTS： There was no mortality or major morbidity encountered in this study. The mean follow-up period after metastasectomy was 26.7 ＋ 28.2 （range： 1-99 mo）, and the median survival time was 20 mo. The 1- and 5-year survival rates were 56% and 26%, respectively. At the end of the follow-up, 1 patient died from hepatic failure without recurrence, 6 died from hepatic failure with a recurrent hepatocellular carcinoma （HCC）, and 4 died from recurrent HCC with cachexia. Among several clinical factors, Kaplan Meier analysis revealed as a treatment for the that liver transplantation primary lesion, grade of cell differentiation, and negative evidence HBV infection were independent predictive factors. On Cox＇s proportional hazard model, there were no significant factors affecting survival after pulmonary metastasectomy in patients with HCC. CONCLUSION： A metastasectomy should be performed before other treatments in selected patients, Although not significant, patients with liver transplantation of a primary HCC survived longer, Liver transplantation might be the most beneficial modality that can offer patients better survival, A multi- institutional and collaborative study would be needed for identifying clinical prognostic factors predicting survival in patients with HCC and lung metastasis.展开更多
Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report he...Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.展开更多
The controversial outcomes in patients with metastatic colorectal cancer(mCRC)highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results.The optimal treatment cyc...The controversial outcomes in patients with metastatic colorectal cancer(mCRC)highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results.The optimal treatment cycles in patients with mCRC for metastasectomy remain undefined.This retrospective study compared the efficacy,safety,and survival of cycles of neoadjuvant chemotherapy/targeted therapy for such patients.Sixty-four patients with mCRC who received neoadjuvant chemotherapy/targeted therapy following metastasectomy were enrolled between January 2018 and April 2022.Twenty-eight patients received 6 cycles of chemotherapy/targeted therapy,whereas 36 patients received≥7 cycles(median,13;range,7–20).Clinical outcomes,including response,progression-free survival(PFS),overall survival(OS),and adverse events,were compared between these two groups.Of the 64 patients,47(73.4%)were included in the response group,and 17(26.6%)were included in the nonresponse group.The analysis revealed chemotherapy/targeted therapy cycle and pretreatment serum carcinoembryonic antigen(CEA)level as independent predictors of the response as well as overall survival and chemotherapy/targeted therapy cycle as an independent predictor of progression(all p<0.05).Furthermore,our results revealed shorter operation time,lower estimated operative blood loss,higher response rate,lower progression rate,and higher survival rate in≥7 cycles of chemotherapy/targeted therapy group(all p<0.05),but no statistical differences in adverse events were observed between the two groups(all p>0.05).The median OS and PFS were 48 months(95%CI,40.855–55.145)and 28 months(95%CI,18.952–37.48)in the≥7-cycle group and 24 months(95%CI,22.038–25.962)and 13 months(95%CI,11.674–14.326)in the 6-cycle group,respectively(both p<0.001).The oncological outcomes in the≥7-cycle group were significantly better than those in the 6-cycle group,without significant increases in adverse events.However,prospective randomized trials are mandatory to confirm the potential advantages of cycle numbers of neoadjuvant chemotherapy/targeted therapy.展开更多
Background and aims:Advanced hepatocellular carcinoma(HCC)with pulmonary metastasis(PM)has a poor prognosis,and optimal treatment strategies remain controversial.This study aimed to compare the long-term outcomes of p...Background and aims:Advanced hepatocellular carcinoma(HCC)with pulmonary metastasis(PM)has a poor prognosis,and optimal treatment strategies remain controversial.This study aimed to compare the long-term outcomes of patients with advanced HCC with PM who were treated with resection of pulmonary metastases versus those treated with targeted therapies combined with immunotherapy.Methods:A retrospective analysis was conducted on the medical records of HCC patients with PM who underwent either pulmonary metastasectomy or immunotherapy combined with targeted therapies at the Eastern Hepatobiliary Surgery Hospital,Changhai Hospital of Shanghai,Fujian Provincial Hospital,and West China Hospital of Sichuan University from September 2013 to October 2022.One-to-one propensity score matching(PSM)was employed to control the influence of potential confounders,and the survival outcomes were compared.Results:A total of 119 HCC patients with PM were included in this study.The overall survival(OS)of patients who underwent pulmonary metastasectomy was significantly longer than that of patients who received immunotherapy targeted combinations(OS:1-year,80.0%vs.59.3%;2-year,31.7%vs.20.3%;3-year,20.0%vs.0;P<0.001).After PSM,the long-term prognosis of the pulmonary metastasectomy group remained significantly better than that of the immunotherapy combination group(OS:1-year,87.0%vs.69.6%;2-year,34.8%vs.30.4%;3-year,21.7%vs.0;P=0.005).Multivariate analysis revealed that treatment allocation(hazard ratio(HR)?2.177,95%confidence interval(CI)=1.068e4.439)and hepatic tumor T stage(HR=2.342,95%CI?1.209e4.538)were independent risk factors for OS.Conclusions:Pulmonary metastasectomy was associated with improved survival compared to immunotherapy combined with targeted therapies and may represent an optimal treatment option for highly selected HCC patients with resectable PM.展开更多
Metastasectomy was initially described in the 1970s as a therapeutic strategy for patients with metastatic renal cell carcinoma.Since that time,systemic therapy options have grown exponentially,most recently with the ...Metastasectomy was initially described in the 1970s as a therapeutic strategy for patients with metastatic renal cell carcinoma.Since that time,systemic therapy options have grown exponentially,most recently with the introduction of immunotherapy.We aimed to review the contemporary literature regarding the role of metastasectomy in the era of targeted therapy and immunotherapy.Historically,metastasectomy has benefited patients with small volume,single-organ metastases,with favorable outcomes amongst younger,healthier patients with metastases to specific sites.The interplay between the employment of metastasectomy and systemic therapy has been limited to small,retrospective series with significant patient selection bias.More recently,investigators have conducted randomized controlled trials exploring the use of targeted therapies in the adjuvant setting after metastasectomy.Initial randomized data suggested no benefit in using sorafenib in this setting,and a subsequent study demonstrated possible harm in using pazopanib after metastasectomy.However,the role of other novel systemic therapies,including immunotherapy,nor the timing of use,have been meaningfully explored.Metastasectomy appears to be a valuable therapeutic option in the properly selected patient,requiring a multi-disciplinary management strategy and,pending future trials,a multimodal treatment approach.展开更多
Objectives:Treatment of metastatic colorectal cancer(mCRC)includes resection of liver metastases(LM),however,no validated biomarker identifies patients most likely to benefit from this procedure.This meta-analysis aim...Objectives:Treatment of metastatic colorectal cancer(mCRC)includes resection of liver metastases(LM),however,no validated biomarker identifies patients most likely to benefit from this procedure.This meta-analysis aimed to assess the impact of the most relevant molecular alterations in cancer-related genes of CRC(i.e.,RAS,BRAF,SMAD4,PIK3CA)as prognostic markers of survival and disease recurrence in patients with mCRC surgically treated by LM resection.Methods:A systematic literature review was performed to identify studies reporting data regarding survival and/or recurrence in patients that underwent complete liver resection for CRC LM,stratified according to RAS,BRAF,PIK3CA,and SMAD4 mutational status.Hazard ratios(HRs)from multivariate analyses were pooled in the meta-analysis and various adjustment strategies for confounding factors were combined.The search was conducted in numerous databases,including MEDLINE(PubMed),Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL)(EBSCO host),and WHO Global Index Medicus,through March 18th,2022.Meta-analyses,editorials,letters to the editor,case reports,studies on other primary cancers,studies with primary metastatic sites other than the liver,studies lacking specific oncological outcome variables or genetic data,non-English language studies,and studies omitting residual disease data from liver metastasectomy were excluded.The remaining 47 studies were summarized in a descriptive table which outlines the key characteristics of each study and final results were graphically presented.Results:RAS mutation status was negatively associated with overall survival(OS)(HR,1.68;95%CI,1.54–1.84)and recurrence free survival(RFS)(HR,1.46;95%CI,1.33–1.61).A negative association was also found for BRAF regarding OS(HR,2.64;95%CI,2.15–3.24)and RFS(HR,1.89;95%CI,1.32–2.73)and SMAD4 regarding OS(HR,1.93;95%CI,1.56–2.38)and RFS(HR,1.95;95%CI,1.31–2.91).For PIK3CA only three studies were eligible and no significant association with either OS or RFS could be highlighted.Conclusion:RAS,BRAF,and SMAD4 are negatively associated with OS and RFS in patients undergoing curative liver metastasectomy from colorectal cancer.No conclusion can be drawn for PIK3CA due to the limited literature availability.These data support the integration of RAS,BRAF,and SMAD4 mutational status in the surgical decision-making for colorectal liver metastasis.Nevertheless,we have to consider several limitations,the major ones being the pooling of results from studies that evaluated patient outcomes as either disease-free survival(DFS)or RFS;the inclusion of patients with minimal residual disease and unconsidered potential confounding factors,such as variability in resectability definitions,chemotherapy use,and a potential interaction between biological markers and pre-and post-resection pharmacological treatments.展开更多
BACKGROUND Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer(CRC)and resectable pulmonary metastases(PM).However,the role of perioperative chemotherap...BACKGROUND Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer(CRC)and resectable pulmonary metastases(PM).However,the role of perioperative chemotherapy after complete resection of isolated PM from patients with CRC patients remains controversial.We hypothesize that perioperative chemotherapy does not provide significant survival benefits for patients undergoing resection of PM from CRC.AIM To determine whether perioperative chemotherapy affects survival after radical resection of isolated PM from CRC.METHODS We retrospectively collected demographic,clinical,and pathologic data on patients who underwent radical surgery for isolated PM from CRC.Cancerspecific survival(CSS)and disease-free survival were calculated using Kaplan-Meier analysis.Inter-group differences were compared using the log-rank test.For multivariate analysis,Cox regression was utilized when indicated.RESULTS This study included 120 patients with a median age of 61.6 years.The 5-year CSS rate was 78.2%,with 36.7% experiencing recurrence.Surgical resection for isolated PM resulted in a 5-year CSS rate of 50.0% for second metastases.Perioperative chemotherapy(P=0.079)did not enhance survival post-resection.Factors associated with improved survival included fewer metastatic lesions[hazard ratio(HR):2.51,P=0.045],longer disease-free intervals(HR:0.35,P=0.016),and wedge lung resections(HR:0.42,P=0.035).Multiple PM predicted higher recurrence risk(HR:2.22,P=0.022).The log-rank test showed no significant difference in CSS between single and repeated metastasectomy(P=0.92).CONCLUSION Perioperative chemotherapy shows no survival benefit post-PM resection in CRC.Disease-free intervals and fewer metastatic lesions predict better survival.Repeated metastasectomy is warranted for eligible patients.展开更多
Surgical resection is the only option of cure for patients with metastatic colorectal cancer(CRC). However, the risk of recurrence within 18 mo after metastasectomy is around 75% and the liver is the most frequent sit...Surgical resection is the only option of cure for patients with metastatic colorectal cancer(CRC). However, the risk of recurrence within 18 mo after metastasectomy is around 75% and the liver is the most frequent site of relapse. The current international guidelines recommend an adjuvant therapy after surgical resection of CRC metastases despite the lower level of evidence(based on the quality of studies in this setting). However, there is still no standard treatment and the effective role of an adjuvant therapy remains controversial. The aim of this review is to report the state-of-art of systemic chemotherapy and regional chemotherapy with hepatic arterial infusion in the management of patients after resection of metastases from CRC, with a literature review and meta-analysis of the relevant randomized controlled trials.展开更多
Oligometastatic non-small cell lung cancer(NSCLC)describes an intermediate stage of NSCLC between localized and widely-disseminated disease.This stage of NSCLC is characterized by a limited number of metastases and a ...Oligometastatic non-small cell lung cancer(NSCLC)describes an intermediate stage of NSCLC between localized and widely-disseminated disease.This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology.Currently,the management of oligometastatic NSCLC involves radical treatment(radiotherapy or surgery)that targets the metastatic lesions and the primary tumor to achieve disease control.This approach offers the potential to achieve prolonged survival in patients who,in the past,would have only received palliative measures.The optimal therapeutic strategies for the different scenarios of oligometastatic disease(intracranial vs extracranial disease,synchronous vs metachronous)remain undefined.Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients,the decision to apply surgery or radiotherapy(with or without systemic treatment)must be based on prognostic factors that allow us to classify patients.This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis.In the future,the molecular or microRNA profiles will likely improve the treatment selection process.The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC,focusing on the role of radiotherapy and surgery.We also discuss areas of controversy and future directions.展开更多
Background:Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM).We performed the present systematic review to evaluate the short-...Background:Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM).We performed the present systematic review to evaluate the short-and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients.Data sources:An electronic search of PubMed database was undertaken to identify all relevant peerreviewed papers published in English between January 20 0 0 and July 2018.Hazard ratios(HR)with 95%confidence interval(95%CI)were calculated for prognostic factors of overall survival(OS).Results:The search yielded 34 studies comprising 3039 patients,with a median overall morbidity of 23%(range 8%–71%),mortality of 0(range 0–6%),and 5-year OS of 42%(range 17%–73%).Pooled analysis showed that primary T3/T4 stage tumor(HR=1.94;95%CI:1.04–3.63),multiple tumors(HR=1.49;95%CI:1.10–2.01),largest liver lesion≥5 cm(HR=1.89;95%CI:1.11–3.23)and positive surgical margin(HR=1.80;95%CI:1.09–2.97)at initial hepatectomy,and high serum level of carcinoembryonic antigen(HR=1.87;95%CI:1.27–2.74),disease-free interval≤12 months(HR=1.34;95%CI:1.10–1.62),multiple tumors(HR=1.64;95%CI:1.32–2.02),largest liver lesion≥5 cm(HR=1.85;95%CI:1.34–2.56),positive surgical margin(HR=2.25;95%CI:1.39–3.65),presence of bilobar disease(HR=1.62;95%CI:1.19–2.20),and extrahepatic metastases(HR=1.60;95%CI:1.23–2.09)at repeat hepatectomy were significantly associated with poor OS.展开更多
BACKGROUND Peritoneal metastasis from colorectal cancer(CRC)carries a poor prognosis in most studies.The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.A...BACKGROUND Peritoneal metastasis from colorectal cancer(CRC)carries a poor prognosis in most studies.The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.AIM To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting.METHODS We retrospectively evaluated progression-free survival(PFS)and overall survival(OS)in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine,oxaliplatin,irinotecan,and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis.Furthermore,univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level.RESULTS Fifty-one patients were treated with the above triplet therapy.Fifteen had peritoneal metastasis.The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor(left-sided primary tumor in 60%of the peritoneal group vs 86%in the nonperitoneal group,P=0.03)and the presence of liver metastasis(40%for the peritoneal group vs 75%for the nonperitoneal group,P=0.01).Univariate analysis for PFS showed a statistically significant difference for age less than 65 years(P=0.034),presence of liver metastasis(P=0.046),lung metastasis(P=0.011),and those who underwent metastasectomy(P=0.001).Only liver metastasis and metastasectomy were statistically significant for OS,with P values of 0.001 and 0.002,respectively.Multivariate analysis showed that age(less than 65 years)and metastasectomy were statistically significant for PFS,with P values of 0.002 and 0.001,respectively.On the other hand,the absence of liver metastasis and metastasectomy were statistically significant for OS,with P values of 0.003 and 0.005,respectively.CONCLUSION Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels.Confirmatory larger studies are warranted.展开更多
Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached...Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival(ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with m RCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it's based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with longterm survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.展开更多
Pulmonary artery intimal sarcoma(PAIS) is a rare tumor with a very poor prognosis. Clinical and radiological findings usually mimic thromboembolic disease, leading to diagnostic delays. The treatment of choice is surg...Pulmonary artery intimal sarcoma(PAIS) is a rare tumor with a very poor prognosis. Clinical and radiological findings usually mimic thromboembolic disease, leading to diagnostic delays. The treatment of choice is surgery, and adjuvant chemotherapy and radiotherapy have limited results. We report the case of a 48-year-old male patient, initially suspected with pulmonary thromboembolism. The angio-CT revealed a filling defect in the pulmonary artery trunk. The patient underwent surgery, resulting in with complete resection of the mass with a diagnosis of PAIS. The tumor progressed rapidly in the lung, requiring surgery of multiple lung metastases. The patient was treated with stereotactic body radiation therapy(SBRT) on two occasions for new pulmonary lesions. In the last follow-up(4 years after initial diagnosis), the patient was disease-free. In conclusion, SBRT proved to be an alternative treatment to metastasectomy, allowing palliative chemotherapy to be delayed or omitted, which may result in improved quality of life.展开更多
BACKGROUND Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare.The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography,pathology and immunohisto...BACKGROUND Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare.The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography,pathology and immunohistochemistry.Here,we describe the use of next-generation sequencing(NGS)for determination of the origin of metastasis and prognostic prediction of colorectal cancer.CASE SUMMARY A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA(T3N0M0)and underwent surgery in April 2014,followed by XELOX adjuvant chemotherapy.The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy.In May 2018,pancreatic metastasis was found and he underwent pancreaticoduodenectomy.After surgery,he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019.Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer.Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer(e.g.,APC,TP53,KRAS and FBXW7).Blood circulating tumor(ct)DNA before adjuvant chemotherapy was undetectable with NGS,suggesting a favorable response to chemotherapy.The patient was alive and well at the latest follow-up visit,achieving a disease-free survival of 17 mo.CONCLUSION The genetic profiles of primary tumor,metastases and ctDNA may have clinical value in auxiliary diagnosis,prognosis and therapeutic decision-making.展开更多
BACKGROUND Gastrointestinal stromal tumor(GIST)usually originates in the stomach,followed by the small intestine,rectum,and other parts of the gastrointestinal tract.The most common sites of metastasis are the liver a...BACKGROUND Gastrointestinal stromal tumor(GIST)usually originates in the stomach,followed by the small intestine,rectum,and other parts of the gastrointestinal tract.The most common sites of metastasis are the liver and peritoneum,whereas spinal metastases from GIST are extremely rare.CASE SUMMARY We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae.A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause.Subsequently,computed tomography(CT)and magnetic resonance imaging(MRI)revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis,which was considered as tumor metastasis.As there were no metastases to vital organs,posterior thoracic and lumbar spinal decompression+adnexal mass resection+pedicle internal fixation was adopted to achieve local cure and prevent nerve compression.The results of histopathological studies were consistent with the metastasis of GIST.No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site.The patient has no neurological symptoms at present.It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital,and the pathological diagnosis of the mass was GIST.CONCLUSION By reviewing 26 previously reported cases of spinal metastasis in GIST,it was found that spinal metastasis of GIST has become more common in recent years,so the possibility of early spinal metastasis should be recognized.CT and MRI are of great value in the diagnosis of spinal metastatic tumors,and pathological biopsy is the gold standard for the diagnosis of metastatic tumors.It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses,decompressing the spinal canal,and stabilizing the spine.展开更多
BACKGROUND The prognosis for oesophageal carcinoma is poor,but once distant metastases emerge the prognosis is considered hopeless.There is no consistent protocol for the early identification and aggressive management...BACKGROUND The prognosis for oesophageal carcinoma is poor,but once distant metastases emerge the prognosis is considered hopeless.There is no consistent protocol for the early identification and aggressive management of metastases.AIM To examine the outcome of a policy of active postoperative surveillance with aggressive treatment of confirmed metastases.METHODS A prospectively maintained database of 205 patients diagnosed with oesophageal carcinoma between 1998 and 2019 and treated with curative intent was interrogated for patients with metastases,either at diagnosis or on follow-up surveillance and treated for cure.This cohort was compared with incomplete clinical responders to neoadjuvant chemoradiotherapy(nCRT)who subsequently underwent surgery on their primary tumour.Overall survival was estimated using the Kaplan-Meier method,and the log-rank test was used to compare survival differences between groups.RESULTS Of 205 patients,11(5.4%)had metastases treated for cure(82%male;median age 60 years;9 adenocarcinoma and 2 squamous cell carcinomas).All had undergone neoadjuvant chemotherapy or chemoradiotherapy,followed by surgery in all but 1 case.Of the 11 patients,4 had metastatic disease at diagnosis,of whom 3 were successfully downstaged with nCRT before definitive surgery;2 of these 4 also developed oligometastatic recurrence and were treated with curative intent.Following definitive treatment,7 had treatment for metachronous oligometastatic disease;5 of whom underwent metastasectomy(adrenal×2;lung×2;liver×1).The median overall survival was 10.9 years[95%confidence interval(CI):0.7-21.0 years],which was statistically significantly longer than incomplete clinical responders undergoing surgery on the primary tumour without metastatic intervention[n=62;median overall survival=1.9(95%CI:1.1-2.7;P=0.012].The cumulative proportion surviving 1,3,and 5 years was 100%,91%,and 61%,respectively compared to 71%,36%,and 25%for incomplete clinical responders undergoing surgery on the primary tumour who did not undergo treatment for metastatic disease.CONCLUSION Metastatic oesophageal cancer represents a unique challenge,but aggressive treatment can be rewarded with impressive survival data.In view of recent advances in targeted therapies,intensive follow-up may yield a greater number of patients with curative potential and thus improved long-term survival.展开更多
An 80-year-old woman underwent a bilateral lung resection for metastases originating from follicular thyroid cancer. The resection was performed 30 years after right hemithyroidectomy to remove the follicular adenoma....An 80-year-old woman underwent a bilateral lung resection for metastases originating from follicular thyroid cancer. The resection was performed 30 years after right hemithyroidectomy to remove the follicular adenoma. Chest X-ray revealed a 30-mm mass shadow in the right lower lung filed. Chest computed tomography revealed a 32-mm mass shadow in right lung segment 10 (S10) and a 15-mm nodular shadow in left S10. Another partial lung resection of left S10 and a right lower lobectomy were performed 3 months later. Although rarely performed, resection of bilateral pulmonary metastases arising from follicular thyroid cancer was conducted for this patient.展开更多
We present a case report of a 63-year-old male who underwent lung resections for metastases originating from gastric cancer 18-year after total gastrectomy with lymphadenectomy. The gastrectomy was performed in 1994;h...We present a case report of a 63-year-old male who underwent lung resections for metastases originating from gastric cancer 18-year after total gastrectomy with lymphadenectomy. The gastrectomy was performed in 1994;histological examination of the original tumor revealed stage II poorly differentiated adenocarcinoma [pT2 (MP), N0, M0]. Chest X-ray and computed tomography in 2012 showed a well-defined tumor, 9 mm in size, at the left S3 of the lung. Thoracoscopic partial resection was performed. The tumor was diagnosed as poorly differentiated carcinoma, most likely metastatic gastric adenocarcinoma. Although rarely performed, resection of pulmonary metastases from carcinoma of the stomach was done to improve the patient’s chances for long-term survival.展开更多
基金Supported by The British Heart Foundation(to Fiorentino F)
文摘Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers,breast and lung,in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal.We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day.Our sources included published citation network analyses,the documented proposal for randomised trials,large systematic reviews,and meta-analysis of observational studies.The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done,or having been done,were not reported.Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias.Randomised controlled trials(RCTs)are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice.One such trial is recruiting and shows that controlled trial are possible.
文摘Colorectal cancer(CRC)is one of the most common cancers worldwide,with 5%-15%of CRC patients eventually developing lung metastasis(LM).Despite doubts about the role of locoregional therapy in the management of systemic disease,many surgeons have performed pulmonary metastasectomy(PM)for CRC in properly selected patients.However,the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies.This article reviews the results of surgical treatment of pulmonary metastases for CRC,focusing on(1)current treatment guidelines and surgical techniques of PM in patients with LM from CRC;(2)outcomes of PM and its prognostic factors;and(3)controversial issues in PM,focusing on repeated metastasectomy,bilateral multiple metas-tases,and combined liver and lung metastasectomy.
基金21C Frontier Functional Human Genome Project from the Ministry of Science & Technology in Korea, No. FG06-11-11
文摘AIM： To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors. METHODS： Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observation period was terminated on May 31, 2007. The surgical outcomes and the clinicopathological factors were compared. RESULTS： There was no mortality or major morbidity encountered in this study. The mean follow-up period after metastasectomy was 26.7 ＋ 28.2 （range： 1-99 mo）, and the median survival time was 20 mo. The 1- and 5-year survival rates were 56% and 26%, respectively. At the end of the follow-up, 1 patient died from hepatic failure without recurrence, 6 died from hepatic failure with a recurrent hepatocellular carcinoma （HCC）, and 4 died from recurrent HCC with cachexia. Among several clinical factors, Kaplan Meier analysis revealed as a treatment for the that liver transplantation primary lesion, grade of cell differentiation, and negative evidence HBV infection were independent predictive factors. On Cox＇s proportional hazard model, there were no significant factors affecting survival after pulmonary metastasectomy in patients with HCC. CONCLUSION： A metastasectomy should be performed before other treatments in selected patients, Although not significant, patients with liver transplantation of a primary HCC survived longer, Liver transplantation might be the most beneficial modality that can offer patients better survival, A multi- institutional and collaborative study would be needed for identifying clinical prognostic factors predicting survival in patients with HCC and lung metastasis.
文摘Bone metastasis is a rare event in patients with gastric cancer, but pathologic fracture, paralysis, pain and hematological disorders associated with the bone metastasis may influence the quality of life. We report herein the case of a 53-year-old man who presented with primary remnant gastric cancer with bone metastasis. The patient requested further investigations after detection of a metastatic lesion in the 2 nd lumbar vertebra during evaluation for back pain that had persisted for 3 mo. No other metastatic lesions were detected. He underwent total gastrectomy and palliative metastasectomy to aid in reduction of symptoms, and he received combination chemotherapy with tegafur(S-1) and cisplatin. The patient survived for about 60 mo after surgery. Currently, there is no treatment guideline for gastric cancer with bone metastasis, and we believe that gastrectomy plus metastasectomy may be an effective therapeutic option for improving qualityof life and survival in patients with resectable primary gastric cancer and bone metastasis.
基金supported by grants through funding from the Ministry of Science and Technology(MOST 109-2314-B-037-046-MY3,MOST110-2314-B-037-097,MOST 111-2314-B-037-070-MY3,MOST 111-2314-B-037-049)the Ministry of Health and Welfare(MOHW111-TDU-B-221-114014)+2 种基金funded by the Health and Welfare Surcharge of on Tobacco Products,and the Kaohsiung Medical University Hospital(KMUH110-0R37,KMUH110-0R38,KMUH110-0M34,KMUH110-0M35,KMUH110-0M36,KMUH-DK(B)110004-3)KMU Center for Cancer Research(KMU-TC111A04-1)KMU Office for Industry-Academic Collaboration(S109036),Kaohsiung Medical University.
文摘The controversial outcomes in patients with metastatic colorectal cancer(mCRC)highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results.The optimal treatment cycles in patients with mCRC for metastasectomy remain undefined.This retrospective study compared the efficacy,safety,and survival of cycles of neoadjuvant chemotherapy/targeted therapy for such patients.Sixty-four patients with mCRC who received neoadjuvant chemotherapy/targeted therapy following metastasectomy were enrolled between January 2018 and April 2022.Twenty-eight patients received 6 cycles of chemotherapy/targeted therapy,whereas 36 patients received≥7 cycles(median,13;range,7–20).Clinical outcomes,including response,progression-free survival(PFS),overall survival(OS),and adverse events,were compared between these two groups.Of the 64 patients,47(73.4%)were included in the response group,and 17(26.6%)were included in the nonresponse group.The analysis revealed chemotherapy/targeted therapy cycle and pretreatment serum carcinoembryonic antigen(CEA)level as independent predictors of the response as well as overall survival and chemotherapy/targeted therapy cycle as an independent predictor of progression(all p<0.05).Furthermore,our results revealed shorter operation time,lower estimated operative blood loss,higher response rate,lower progression rate,and higher survival rate in≥7 cycles of chemotherapy/targeted therapy group(all p<0.05),but no statistical differences in adverse events were observed between the two groups(all p>0.05).The median OS and PFS were 48 months(95%CI,40.855–55.145)and 28 months(95%CI,18.952–37.48)in the≥7-cycle group and 24 months(95%CI,22.038–25.962)and 13 months(95%CI,11.674–14.326)in the 6-cycle group,respectively(both p<0.001).The oncological outcomes in the≥7-cycle group were significantly better than those in the 6-cycle group,without significant increases in adverse events.However,prospective randomized trials are mandatory to confirm the potential advantages of cycle numbers of neoadjuvant chemotherapy/targeted therapy.
基金supported by the School-level project of Naval Medical University(No.2022MS038)National Natural Science Foundation of China(No.82073293)National Key R&D Program of China(No.2022YFC2503700).
文摘Background and aims:Advanced hepatocellular carcinoma(HCC)with pulmonary metastasis(PM)has a poor prognosis,and optimal treatment strategies remain controversial.This study aimed to compare the long-term outcomes of patients with advanced HCC with PM who were treated with resection of pulmonary metastases versus those treated with targeted therapies combined with immunotherapy.Methods:A retrospective analysis was conducted on the medical records of HCC patients with PM who underwent either pulmonary metastasectomy or immunotherapy combined with targeted therapies at the Eastern Hepatobiliary Surgery Hospital,Changhai Hospital of Shanghai,Fujian Provincial Hospital,and West China Hospital of Sichuan University from September 2013 to October 2022.One-to-one propensity score matching(PSM)was employed to control the influence of potential confounders,and the survival outcomes were compared.Results:A total of 119 HCC patients with PM were included in this study.The overall survival(OS)of patients who underwent pulmonary metastasectomy was significantly longer than that of patients who received immunotherapy targeted combinations(OS:1-year,80.0%vs.59.3%;2-year,31.7%vs.20.3%;3-year,20.0%vs.0;P<0.001).After PSM,the long-term prognosis of the pulmonary metastasectomy group remained significantly better than that of the immunotherapy combination group(OS:1-year,87.0%vs.69.6%;2-year,34.8%vs.30.4%;3-year,21.7%vs.0;P=0.005).Multivariate analysis revealed that treatment allocation(hazard ratio(HR)?2.177,95%confidence interval(CI)=1.068e4.439)and hepatic tumor T stage(HR=2.342,95%CI?1.209e4.538)were independent risk factors for OS.Conclusions:Pulmonary metastasectomy was associated with improved survival compared to immunotherapy combined with targeted therapies and may represent an optimal treatment option for highly selected HCC patients with resectable PM.
文摘Metastasectomy was initially described in the 1970s as a therapeutic strategy for patients with metastatic renal cell carcinoma.Since that time,systemic therapy options have grown exponentially,most recently with the introduction of immunotherapy.We aimed to review the contemporary literature regarding the role of metastasectomy in the era of targeted therapy and immunotherapy.Historically,metastasectomy has benefited patients with small volume,single-organ metastases,with favorable outcomes amongst younger,healthier patients with metastases to specific sites.The interplay between the employment of metastasectomy and systemic therapy has been limited to small,retrospective series with significant patient selection bias.More recently,investigators have conducted randomized controlled trials exploring the use of targeted therapies in the adjuvant setting after metastasectomy.Initial randomized data suggested no benefit in using sorafenib in this setting,and a subsequent study demonstrated possible harm in using pazopanib after metastasectomy.However,the role of other novel systemic therapies,including immunotherapy,nor the timing of use,have been meaningfully explored.Metastasectomy appears to be a valuable therapeutic option in the properly selected patient,requiring a multi-disciplinary management strategy and,pending future trials,a multimodal treatment approach.
基金partially funded by Italian Ministry of Health—Ricerca Corrente(no grant number).
文摘Objectives:Treatment of metastatic colorectal cancer(mCRC)includes resection of liver metastases(LM),however,no validated biomarker identifies patients most likely to benefit from this procedure.This meta-analysis aimed to assess the impact of the most relevant molecular alterations in cancer-related genes of CRC(i.e.,RAS,BRAF,SMAD4,PIK3CA)as prognostic markers of survival and disease recurrence in patients with mCRC surgically treated by LM resection.Methods:A systematic literature review was performed to identify studies reporting data regarding survival and/or recurrence in patients that underwent complete liver resection for CRC LM,stratified according to RAS,BRAF,PIK3CA,and SMAD4 mutational status.Hazard ratios(HRs)from multivariate analyses were pooled in the meta-analysis and various adjustment strategies for confounding factors were combined.The search was conducted in numerous databases,including MEDLINE(PubMed),Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL)(EBSCO host),and WHO Global Index Medicus,through March 18th,2022.Meta-analyses,editorials,letters to the editor,case reports,studies on other primary cancers,studies with primary metastatic sites other than the liver,studies lacking specific oncological outcome variables or genetic data,non-English language studies,and studies omitting residual disease data from liver metastasectomy were excluded.The remaining 47 studies were summarized in a descriptive table which outlines the key characteristics of each study and final results were graphically presented.Results:RAS mutation status was negatively associated with overall survival(OS)(HR,1.68;95%CI,1.54–1.84)and recurrence free survival(RFS)(HR,1.46;95%CI,1.33–1.61).A negative association was also found for BRAF regarding OS(HR,2.64;95%CI,2.15–3.24)and RFS(HR,1.89;95%CI,1.32–2.73)and SMAD4 regarding OS(HR,1.93;95%CI,1.56–2.38)and RFS(HR,1.95;95%CI,1.31–2.91).For PIK3CA only three studies were eligible and no significant association with either OS or RFS could be highlighted.Conclusion:RAS,BRAF,and SMAD4 are negatively associated with OS and RFS in patients undergoing curative liver metastasectomy from colorectal cancer.No conclusion can be drawn for PIK3CA due to the limited literature availability.These data support the integration of RAS,BRAF,and SMAD4 mutational status in the surgical decision-making for colorectal liver metastasis.Nevertheless,we have to consider several limitations,the major ones being the pooling of results from studies that evaluated patient outcomes as either disease-free survival(DFS)or RFS;the inclusion of patients with minimal residual disease and unconsidered potential confounding factors,such as variability in resectability definitions,chemotherapy use,and a potential interaction between biological markers and pre-and post-resection pharmacological treatments.
基金Supported by the 2020 National and Provincial Clinical Key Specialty Capacity Building Projects,No.2020641.
文摘BACKGROUND Numerous studies have assessed surgical resection as a standard treatment option for patients with colorectal cancer(CRC)and resectable pulmonary metastases(PM).However,the role of perioperative chemotherapy after complete resection of isolated PM from patients with CRC patients remains controversial.We hypothesize that perioperative chemotherapy does not provide significant survival benefits for patients undergoing resection of PM from CRC.AIM To determine whether perioperative chemotherapy affects survival after radical resection of isolated PM from CRC.METHODS We retrospectively collected demographic,clinical,and pathologic data on patients who underwent radical surgery for isolated PM from CRC.Cancerspecific survival(CSS)and disease-free survival were calculated using Kaplan-Meier analysis.Inter-group differences were compared using the log-rank test.For multivariate analysis,Cox regression was utilized when indicated.RESULTS This study included 120 patients with a median age of 61.6 years.The 5-year CSS rate was 78.2%,with 36.7% experiencing recurrence.Surgical resection for isolated PM resulted in a 5-year CSS rate of 50.0% for second metastases.Perioperative chemotherapy(P=0.079)did not enhance survival post-resection.Factors associated with improved survival included fewer metastatic lesions[hazard ratio(HR):2.51,P=0.045],longer disease-free intervals(HR:0.35,P=0.016),and wedge lung resections(HR:0.42,P=0.035).Multiple PM predicted higher recurrence risk(HR:2.22,P=0.022).The log-rank test showed no significant difference in CSS between single and repeated metastasectomy(P=0.92).CONCLUSION Perioperative chemotherapy shows no survival benefit post-PM resection in CRC.Disease-free intervals and fewer metastatic lesions predict better survival.Repeated metastasectomy is warranted for eligible patients.
文摘Surgical resection is the only option of cure for patients with metastatic colorectal cancer(CRC). However, the risk of recurrence within 18 mo after metastasectomy is around 75% and the liver is the most frequent site of relapse. The current international guidelines recommend an adjuvant therapy after surgical resection of CRC metastases despite the lower level of evidence(based on the quality of studies in this setting). However, there is still no standard treatment and the effective role of an adjuvant therapy remains controversial. The aim of this review is to report the state-of-art of systemic chemotherapy and regional chemotherapy with hepatic arterial infusion in the management of patients after resection of metastases from CRC, with a literature review and meta-analysis of the relevant randomized controlled trials.
文摘Oligometastatic non-small cell lung cancer(NSCLC)describes an intermediate stage of NSCLC between localized and widely-disseminated disease.This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology.Currently,the management of oligometastatic NSCLC involves radical treatment(radiotherapy or surgery)that targets the metastatic lesions and the primary tumor to achieve disease control.This approach offers the potential to achieve prolonged survival in patients who,in the past,would have only received palliative measures.The optimal therapeutic strategies for the different scenarios of oligometastatic disease(intracranial vs extracranial disease,synchronous vs metachronous)remain undefined.Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients,the decision to apply surgery or radiotherapy(with or without systemic treatment)must be based on prognostic factors that allow us to classify patients.This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis.In the future,the molecular or microRNA profiles will likely improve the treatment selection process.The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC,focusing on the role of radiotherapy and surgery.We also discuss areas of controversy and future directions.
基金supported by a grant from Foundation of Xiamen Science and Technology Bureau(3502Z20174074)
文摘Background:Frequent recurrent hepatic metastasis after hepatic metastasectomy is a major obstacle in the treatment of colorectal liver metastasis(CRLM).We performed the present systematic review to evaluate the short-and long-term outcomes after repeat hepatectomy for recurrent CRLM and determine factors associated with survival in these patients.Data sources:An electronic search of PubMed database was undertaken to identify all relevant peerreviewed papers published in English between January 20 0 0 and July 2018.Hazard ratios(HR)with 95%confidence interval(95%CI)were calculated for prognostic factors of overall survival(OS).Results:The search yielded 34 studies comprising 3039 patients,with a median overall morbidity of 23%(range 8%–71%),mortality of 0(range 0–6%),and 5-year OS of 42%(range 17%–73%).Pooled analysis showed that primary T3/T4 stage tumor(HR=1.94;95%CI:1.04–3.63),multiple tumors(HR=1.49;95%CI:1.10–2.01),largest liver lesion≥5 cm(HR=1.89;95%CI:1.11–3.23)and positive surgical margin(HR=1.80;95%CI:1.09–2.97)at initial hepatectomy,and high serum level of carcinoembryonic antigen(HR=1.87;95%CI:1.27–2.74),disease-free interval≤12 months(HR=1.34;95%CI:1.10–1.62),multiple tumors(HR=1.64;95%CI:1.32–2.02),largest liver lesion≥5 cm(HR=1.85;95%CI:1.34–2.56),positive surgical margin(HR=2.25;95%CI:1.39–3.65),presence of bilobar disease(HR=1.62;95%CI:1.19–2.20),and extrahepatic metastases(HR=1.60;95%CI:1.23–2.09)at repeat hepatectomy were significantly associated with poor OS.
文摘BACKGROUND Peritoneal metastasis from colorectal cancer(CRC)carries a poor prognosis in most studies.The majority of those studies used either a single-agent or doublet chemotherapy regimen in the first-line setting.AIM To investigate the prognostic significance of peritoneal metastasis in a cohort of patients treated with triplet chemotherapy in the first-line setting.METHODS We retrospectively evaluated progression-free survival(PFS)and overall survival(OS)in 51 patients with metastatic CRC treated in a prospective clinical trial with capecitabine,oxaliplatin,irinotecan,and bevacizumab in the first-line setting according to the presence and absence of peritoneal metastasis.Furthermore,univariate and multivariate analyses for PFS and OS were performed to assess the prognostic significance of peritoneal metastasis at the multivariate level.RESULTS Fifty-one patients were treated with the above triplet therapy.Fifteen had peritoneal metastasis.The patient characteristics of both groups showed a significant difference in the sidedness of the primary tumor(left-sided primary tumor in 60%of the peritoneal group vs 86%in the nonperitoneal group,P=0.03)and the presence of liver metastasis(40%for the peritoneal group vs 75%for the nonperitoneal group,P=0.01).Univariate analysis for PFS showed a statistically significant difference for age less than 65 years(P=0.034),presence of liver metastasis(P=0.046),lung metastasis(P=0.011),and those who underwent metastasectomy(P=0.001).Only liver metastasis and metastasectomy were statistically significant for OS,with P values of 0.001 and 0.002,respectively.Multivariate analysis showed that age(less than 65 years)and metastasectomy were statistically significant for PFS,with P values of 0.002 and 0.001,respectively.On the other hand,the absence of liver metastasis and metastasectomy were statistically significant for OS,with P values of 0.003 and 0.005,respectively.CONCLUSION Peritoneal metastasis in patients with metastatic CRC treated with first-line triple chemotherapy does not carry prognostic significance at univariate and multivariate levels.Confirmatory larger studies are warranted.
文摘Metastatic renal cell carcinoma(m RCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival(ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with m RCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it's based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with longterm survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.
文摘Pulmonary artery intimal sarcoma(PAIS) is a rare tumor with a very poor prognosis. Clinical and radiological findings usually mimic thromboembolic disease, leading to diagnostic delays. The treatment of choice is surgery, and adjuvant chemotherapy and radiotherapy have limited results. We report the case of a 48-year-old male patient, initially suspected with pulmonary thromboembolism. The angio-CT revealed a filling defect in the pulmonary artery trunk. The patient underwent surgery, resulting in with complete resection of the mass with a diagnosis of PAIS. The tumor progressed rapidly in the lung, requiring surgery of multiple lung metastases. The patient was treated with stereotactic body radiation therapy(SBRT) on two occasions for new pulmonary lesions. In the last follow-up(4 years after initial diagnosis), the patient was disease-free. In conclusion, SBRT proved to be an alternative treatment to metastasectomy, allowing palliative chemotherapy to be delayed or omitted, which may result in improved quality of life.
基金National Natural Science Foundation of China,No.81902385Medical Research Projects of Jiangsu Province,No.Y2018094 and No.H2018056and Science and Technology Project of Jiangsu Province,No.BK20201173。
文摘BACKGROUND Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare.The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography,pathology and immunohistochemistry.Here,we describe the use of next-generation sequencing(NGS)for determination of the origin of metastasis and prognostic prediction of colorectal cancer.CASE SUMMARY A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA(T3N0M0)and underwent surgery in April 2014,followed by XELOX adjuvant chemotherapy.The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy.In May 2018,pancreatic metastasis was found and he underwent pancreaticoduodenectomy.After surgery,he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019.Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer.Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer(e.g.,APC,TP53,KRAS and FBXW7).Blood circulating tumor(ct)DNA before adjuvant chemotherapy was undetectable with NGS,suggesting a favorable response to chemotherapy.The patient was alive and well at the latest follow-up visit,achieving a disease-free survival of 17 mo.CONCLUSION The genetic profiles of primary tumor,metastases and ctDNA may have clinical value in auxiliary diagnosis,prognosis and therapeutic decision-making.
文摘BACKGROUND Gastrointestinal stromal tumor(GIST)usually originates in the stomach,followed by the small intestine,rectum,and other parts of the gastrointestinal tract.The most common sites of metastasis are the liver and peritoneum,whereas spinal metastases from GIST are extremely rare.CASE SUMMARY We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae.A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause.Subsequently,computed tomography(CT)and magnetic resonance imaging(MRI)revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis,which was considered as tumor metastasis.As there were no metastases to vital organs,posterior thoracic and lumbar spinal decompression+adnexal mass resection+pedicle internal fixation was adopted to achieve local cure and prevent nerve compression.The results of histopathological studies were consistent with the metastasis of GIST.No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site.The patient has no neurological symptoms at present.It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital,and the pathological diagnosis of the mass was GIST.CONCLUSION By reviewing 26 previously reported cases of spinal metastasis in GIST,it was found that spinal metastasis of GIST has become more common in recent years,so the possibility of early spinal metastasis should be recognized.CT and MRI are of great value in the diagnosis of spinal metastatic tumors,and pathological biopsy is the gold standard for the diagnosis of metastatic tumors.It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses,decompressing the spinal canal,and stabilizing the spine.
文摘BACKGROUND The prognosis for oesophageal carcinoma is poor,but once distant metastases emerge the prognosis is considered hopeless.There is no consistent protocol for the early identification and aggressive management of metastases.AIM To examine the outcome of a policy of active postoperative surveillance with aggressive treatment of confirmed metastases.METHODS A prospectively maintained database of 205 patients diagnosed with oesophageal carcinoma between 1998 and 2019 and treated with curative intent was interrogated for patients with metastases,either at diagnosis or on follow-up surveillance and treated for cure.This cohort was compared with incomplete clinical responders to neoadjuvant chemoradiotherapy(nCRT)who subsequently underwent surgery on their primary tumour.Overall survival was estimated using the Kaplan-Meier method,and the log-rank test was used to compare survival differences between groups.RESULTS Of 205 patients,11(5.4%)had metastases treated for cure(82%male;median age 60 years;9 adenocarcinoma and 2 squamous cell carcinomas).All had undergone neoadjuvant chemotherapy or chemoradiotherapy,followed by surgery in all but 1 case.Of the 11 patients,4 had metastatic disease at diagnosis,of whom 3 were successfully downstaged with nCRT before definitive surgery;2 of these 4 also developed oligometastatic recurrence and were treated with curative intent.Following definitive treatment,7 had treatment for metachronous oligometastatic disease;5 of whom underwent metastasectomy(adrenal×2;lung×2;liver×1).The median overall survival was 10.9 years[95%confidence interval(CI):0.7-21.0 years],which was statistically significantly longer than incomplete clinical responders undergoing surgery on the primary tumour without metastatic intervention[n=62;median overall survival=1.9(95%CI:1.1-2.7;P=0.012].The cumulative proportion surviving 1,3,and 5 years was 100%,91%,and 61%,respectively compared to 71%,36%,and 25%for incomplete clinical responders undergoing surgery on the primary tumour who did not undergo treatment for metastatic disease.CONCLUSION Metastatic oesophageal cancer represents a unique challenge,but aggressive treatment can be rewarded with impressive survival data.In view of recent advances in targeted therapies,intensive follow-up may yield a greater number of patients with curative potential and thus improved long-term survival.
文摘An 80-year-old woman underwent a bilateral lung resection for metastases originating from follicular thyroid cancer. The resection was performed 30 years after right hemithyroidectomy to remove the follicular adenoma. Chest X-ray revealed a 30-mm mass shadow in the right lower lung filed. Chest computed tomography revealed a 32-mm mass shadow in right lung segment 10 (S10) and a 15-mm nodular shadow in left S10. Another partial lung resection of left S10 and a right lower lobectomy were performed 3 months later. Although rarely performed, resection of bilateral pulmonary metastases arising from follicular thyroid cancer was conducted for this patient.
文摘We present a case report of a 63-year-old male who underwent lung resections for metastases originating from gastric cancer 18-year after total gastrectomy with lymphadenectomy. The gastrectomy was performed in 1994;histological examination of the original tumor revealed stage II poorly differentiated adenocarcinoma [pT2 (MP), N0, M0]. Chest X-ray and computed tomography in 2012 showed a well-defined tumor, 9 mm in size, at the left S3 of the lung. Thoracoscopic partial resection was performed. The tumor was diagnosed as poorly differentiated carcinoma, most likely metastatic gastric adenocarcinoma. Although rarely performed, resection of pulmonary metastases from carcinoma of the stomach was done to improve the patient’s chances for long-term survival.
