As the most common primary malignant bone tumor in children and adolescents, osteosarcoma has the characteristics of high malignancy, easy metastasis and poor prognosis. The recurrence, metastasis and multi-drug resistance of osteosarcoma are the main problems that limit the therapeutic effect and survival rate of osteosarcoma. Among them, lung metastasis is often the main target organ for distant metastasis of osteosarcoma. In recent years, people have paid attention to the signaling pathway of the occurrence and development of osteosarcoma and made in-depth studies on its mechanism. A variety of relevant signaling pathways have been constantly clarified. At present, there is still a lack of systematic and multi-directional exploration and summary on the signaling pathway related to the pulmonary metastasis of osteosarcoma. This paper explores the new direction of targeted therapy for osteosarcoma by elucidating the relationship between the signaling pathway associated with osteosarcoma and the pulmonary metastasis of osteosarcoma.
Abstract：Pulmonary metastasectomy is an important curative option for patients with osteogenic and softtissue sarcoma spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration when planning pulmonary metastasectomy include: preoperative assessment of the operation index and contraindications, choice of surgical strategies, pulmonary parenchymal preservation, and the role of lymphadenectomy. With the development of iconography and chemotherapy, the emergence of targeted drugs, and the innovation of radiotherapy, the concept of the diagnosis and treatment for pulmonary metastases from osteogenic and softtissue sarcoma is also undergoing great changes.
Abstract： Pulmonary metastasectomy is an option for patients with metastatic tumor of lung. Numerous retrospectivestudies have demonstrated that complete control of primary tumor and complete resection of metastases limited to thelungs may be associated with prolonged survival. Speci?c issues require consideration when planning pulmonary metastasectomy. Regardless of histological type of primary tumor, complete resection is the most important prognostic factor. The other two important prognostic factors are long disease interval and limited number of metastatic tumor of lung. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access is recommended. Pulmonary hilar and mediastinal lymph node metastases are some relative contraindications for this surgery. Nowdays preoperative imaging examinations still have limitations in detecting all the lung metastases. Some data emphasize the importance of considering patients for extended resection in metastatic tumor of lung. Repeat resection after previous metastasectomies can be of benefit under certain circumstances so we should remove as little healthy lung tissue as possible. In this review, we discuss about some disputed issues in order to establish a useful criterion for consideration of pulmonary metastasectomy.
ObjectiveTo compare the clinical effects of lobectomy and sublobar resection in the treatment of lung metastasis and to analyze the factors affecting patient prognosis. MethodsA retrospective analysis was performed on the clinical data of 165 patients with pulmonary metastasis who underwent thoracic surgery at the Affiliated Tumor Hospital of Xinjiang Medical University between March 2010 and May 2021, including 67 males and 98 females, with a median age of 52 (44, 62) years. According to the operation methods, patients were divided into a lobectomy group and a sublobar resection group. The clinical data of the patients were compared between the two groups. The Cox proportional hazard model was used for univariate and multivariate analyses. ResultsThe 3- and 5-year overall survival rates were 60.0% and 34.3%, respectively, and the median survival time was 24 months. The 3- and 5-year disease-free survival rates were 39.4% and 23.7%, respectively. Compared with the lobectomy group, the sublobar resection group had shorter operation time for pulmonary metastases (P<0.001), less intraoperative blood loss (P<0.001), less drainage volume on the first day after surgery (P<0.001), less incidence of prolonged air leak (P=0.004), shorter drainage tube indwelling time (P=0.002), and shorter postoperative hospital stay (P=0.023). The disease-free survival time after sublobar resection and lobectomy was 26 months and 24 months, respectively, with no statistical difference (P=0.970). The total survival time of the two groups was 73 months and 69 months, respectively, with no significant difference (P=0.697). Multivariate analysis showed that sex [HR=0.616, 95%CI (0.390, 0.974), P=0.038], disease-free interval [HR=1.753, 95%CI (1.082, 2.842), P=0.023], and postoperative adjuvant therapy [HR=2.638, 95%CI (1.352, 5.147), P=0.004] were independent influencing factors for disease-free survival of patients who underwent pulmonary metastasectomy. Disease-free interval [HR=2.033, 95%CI (1.062, 3.894), P=0.032] and preoperative carcinoembryonic antigen level [HR=2.708, 95%CI (1.420, 5.163), P=0.002] were independent factors influencing the overall survival of patients in this group. ConclusionSublobar resection provides a safe and effective treatment option for patients with pulmonary metastasis on the premise of ensuring R0 resection of lung metastasis. Sex, disease-free interval, preoperative carcinoembryonic antigen level, and adjuvant therapy after pulmonary metastasectomy are the independent influencing factors for the prognosis.
ObjectiveTo summarize the experiences and lessons of diagnosis and treatment of follicular thyroid carcinoma (FTC) with lymph node and lung metastases.MethodThe clinicopathologic data of a case of FTC with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs were analyzed retrospectively.ResultsThe case was a 39 years old male patient, who was diagnosed with the right FTC with multiple metastases. The total thyroidectomy+lymph node dissection in bilateral central and bilateral neck regions+lymph node dissection in the left axillary was intended to perform in the Department of Thyroid and Parathyroid Surgery of the West China Hospital. During the operation, the upper mediastinal lymph node fusion was found, and the tumor was tightly adhered with the recurrent laryngeal nerve, the signal was lost after the adhesion separation. In the right central area, the enlarged lymph nodes penetrated down into the upper mediastinum. More enlarged lymph nodes extended upward into the subclavian area in the left armpit. Considering a longer operation time and about 2 000 mL bleeding amount, the mediastinal and left neck operation was decided to perform in the second stage after consulting with the thoracic surgeon. At more than 6 months after the operation, the patient underwent the mediastinal lymph node dissection+superior vena cava (SVC) restoration+metastatic tumor resection+SVC shunt operation in the Department of Thoracic Surgery of the West China Hospital. The operation was successful, without hypocalcemia, dyspnea, and other complications. At 8 months after the operation, the third operation was performed in the Department of Thyroid and Parathyroid Surgery of the West China Hospital, that was, total residual thyroidectomy+left central and left cervical lymph node dissection+left axillary lymph node dissection (level Ⅱ–Ⅲ). The postoperative pronounce didn’t change, without hypocalcemia and other complications. Three times of iodine ablation therapy were performed in the West China Hospital. The occupy didn’t be found by the neck ultrasound and the pulmonary metastasis was stable by the CT during the regular follow-up.ConclusionsAccording to this case, neck surgery with SVC syndrome, SVC syndrome should be treated preferentially. For patient with complicated condition, unconventional approaches could be selected according to actual condition of patient, and staging surgery might be a good choice.
Objective To summarize the recent progress in the research on the mechanism and treatment of lung metastasis of hepatocellular carcinoma, in order to provide reference for clinical workers to systematically treat patients with lung metastasis of hepatocellular carcinoma, guarantee their survival and improve their quality of life. Method The literatures about mechanism and clinical treatment of lung metastasis of hepatocellular carcinoma in recent years were reviewed. Results At home and abroad, there was no unified treatment standard for patients with lung metastasis of hepatocellular carcinoma. For patients with early metastasis, some scholars proposed resection of the metastasis, or ablation, radiotherapy and other methods for the metastatic site. For patients with advanced lung metastasis, systematic therapy was used. Conclusions The treatment effect is not ideal due to the limitations of few clinical studies, low level of evidence and complex disease mechanism, and there is no unified treatment standard. Therefore, in view of the differences between patients and the specific reality in clinical treatment, personalized treatment is implemented.
ObjectiveTo investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer.MethodsRetrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared.ResultsSublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554).ConclusionConsidering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
Objective To investigate prognostic factors of surgery treatment for pulmonary metastasis from rectal cancer. Methods From September 1973 to September 2007,43 patients, 12 women and 31 men with mean age of 58 years (ranged 36-77 years) were diagnosed and performed 45 curative resections of pulmonary metastases from rectal cancer in this hospital.Followup informations were collected including：the clinical parameters include age, sex, pTNM/UICC stage,the number, maximum diameter of lung metastases，the preoperative serum carcinoembryonic antigen(CEA) levels, the interval between resection of primary tumor and diagnosis of lung metastasis (disease-free interval (DFI)，the presence of hilar/mediastinal tumorinfiltrated lymph nodes，intraoperative blood loss and postoperative chemotherapy schemes. After lung metastasectomy，probability of survival was calculated according to the method of KaplanMeier.All factors that may have affected the survival were entered into Cox’s proportional hazards regression model to identify significant variables associated with survival. Results Fourty-three patients were selected fully follow-up cases, with mean period ranged from 1-103 months (median 54 months). There was 1 early postoperative mortality from cardiac complications (2.3%). The probability of survival at 1, 3, and 5 years was 91.3％，56.4% and 32.2%, respectively，Median overall survival was 42.6 months. The DFI was found to be 28.6 months（ranged 0-114 months）. Hilar or mediastinal tumorinvolvedlymph nodes were found in 9 patients. Fiveyear survival was 42.6% for patients with CEA＜5ng／ml and 18.0% for those with CEA≥5ng／ml (P=0.009).Fiveyear survival rate was 53.3% for patients with DFI≥3 years, 32.3% for those with1 year＜DFI＜3 years and 15.1% for those with DFI ≤1 year (P=0.036). In the multivariate analysis,the overall survival was significantly correlated with the preoperative serum CEA level and DFI (P=0.013,0.016),respectively. Conclusion Patients with pulmonary metastases from colorectal carcinoma will benefit from pulmonary metastasectomy. Patients with preoperative serum CEA ＜5ng／ml and DFI ≥3 years have an significantly long-term survival.
We reported a 32 years female patient in whom lung metastasis from breast cancer was presented as solitary pulmonary pure ground-glass opacity (GGO) lesion. The patient received rational preoperative examinations and surgery though the preoperative diagnosis was not accurate. Because of different therapy strategies and purposes, it is crucial to make distinction of atypical metastases from primary cancers. Thus, for patients with a history of malignancy, possible metastasis should be taken into consideration if new GGO was found on the CT. Besides this, the follow-up interval of CT should be shortened appropriately, preoperative examinations and surgical procedures should be made according to the suggestions of multidisciplinary team.
Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.