The diagnostic frequency of multiple pulmonary tumor nodules has increased significantly in clinical practice. Among patients with multiple pulmonary nodules, distinguishing between separate primary lung carcinomas and intrapulmonary metastases is critical for accurate tumor staging, therapeutic decision-making, and prognostic evaluation. The consensus document "Differentiating separate primary lung adenocarcinomas from intrapulmonary metastases with emphasis on pathological and molecular considerations: Recommendations from the International Association for the Study of Lung Cancer Pathology Committee" highlights the pivotal role of integrated pathological and molecular analyses in diagnosing and differentiating primary lung adenocarcinomas from intrapulmonary metastatic lesions. It further proposes a combined four-step histologic and molecular classification algorithm for addressing multiple pulmonary tumor nodules of adenocarcinoma histology, providing clinicians with enhanced diagnostic tools to refine staging accuracy, guide therapeutic strategies, and improve prognostic predictions for lung adenocarcinoma. Building on current advancements in global research, this article offers a comprehensive interpretation of the consensus recommendations.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
ObjectiveTo study the preventive effect of zoledronic acid on the bone metastases of breast cancer. MethodsFour hundred and eighteen female patients with infiltrating ductal carcinoma who were underwent surgery in The First Affiliated Hospital of Xinjiang Medical University from Jan. 2006 to Dec. 2009 were collected and divided into 2 group, patients of prevention group accepted the preventive remedy of zoledronic acid(n=216), but patients of control group didn't accept(n=202). Comparison of incidence of bone metastases and recurrence was performed. ResultsThere were 37(17.13%) patients suffered bone metastases in prevention group and 73(36.14%) patients in control group, so the incidence of bone metastases was higher in control group(χ2=19.45, P<0.05). But there were no significant difference on incidence of pulmonary metastasis, liver metastases, other parts of metastases, multiple organ metastases, and recurrence(P>0.05). ConclusionZoledronic acid could significantly reduce the incidence of bone metastases for patients with breast cancer, who underwent chemotherapy of conventional dose after operation, and it can effectively improve the prognosis of patients with breast cancer.
ObjectiveTo explore the effect of liver metastases of intraoperative and postoperative portal vein chemotherapy and combined with folfox4 regimen chemotherapy for patients with obstrutive colorectal cancer. MethodsA total of 94 obsrutive colorectal cancer patients that could be radical resection were collected from February 2007 to May 2011 in our hospital and divided into two group. Forty-six patients in treatment group received portal vein chemotherapy after the portal vein pump were placed intraoperative, and 3-4 weeks after operation taken FOLFOX4 chemotherapy combined with portal vein infusion chemotherapy 6 courses. Forty-eight patients in the control group received only FOLFOX4 chemotherapy 6 courses 3-4 weeks after operation. Ninety-four patients were followed up for 3 years to observe the incidence of postoperative liver metastasis, at the same time comparing two groups of clinic toxicity during chemotherapy. ResultsIn three years after operation the incidence of liver metastasis were 21.7% in treatment group (10 cases had hepatic metastases), 58.3% in control group (28 cases had liver metastases), the difference in two groups was statistically significant(P < 0.01). Comparing the clinical toxicity in two group, AST in treatment group increased on first day (P < 0.01), and recovered normal on third day (P > 0.05) after operation. There were no marked difference in renal function, ALT, ALP, GGT, and LDH of liver function, medullary restraining, and reaction of gastrointestinal tract (P > 0.05). ConclusionChemotherapy via portal vein intraoperative and postoperativ combined postoperative FOLFOX4 chemotherapy can reduce the risk of postoperative liver metastasis for the patients with obstrutive colorectal cancer.
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.
Objective To use meta-analysis method to assess the efficacy of fluorine-18fluorode-oxyglucose positron emission tomography/computed tomography (PET/CT) (18F-FDG-PET/CT) scan and 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scan (BS) on early diagnosis of bone metastases of cancer. Methods Computer-based retrieval was conducted on MEDLINE, PubMed, EMbase, Ovid, and The Cochrane Library (from their establishment to 2010) to search reports about diagnosing bone metastases of cancer with 18FDG-PET/CT and 99Tcm-MDP Bone Scan. Three reviewers independently selected the studies according to the inclusion and exclusion criteria, collected the data, and evaluated the quality. MetaDisc software was adopted to conduct meta-analyses. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, the summary receiving operating characteristic (SROC) curve was drawn, and the areas under the curve (AUC) and Q were measured. Results Five studies were included. The results of meta-analyses showed that the pooled sensitivity of 18FDG-PET/CT and 99Tcm-MDP BS in the diagnosis of bone metastases was 0.95 (95%CI 0.90 to 0.97) and 0.77 (95%CI 0.71 to 0.83), respectively; the pooled specificity was 0.98 (95%CI 0.97 to 0.99) and 0.90 (95%CI 0.88 to 0.92), respectively; the pooled DOR was 602.81 (95%CI 214.07 to 1697.51) and 41.37 (95%CI 8.15 to 210.05), respectively; the AUC was 0.984 2 and 0.901 7, respectively; and the Q index was 0.945 4 and 0.833 1, respectively. Conclusion The 18F-FDG PET/CT is more effective than the 99Tcm-MDP bone scan in the early diagnosis of bone metastases in cancer.
Objective To determine the efficacy of radioisotopes to control metastasic pain in patients with tumor bone metastases and complications due to bone metastases (hypercalcaemia, bone fracture and spinal cord compression). The effectiveness of radioisotopes in relation to patient survival and adverse effects were also assessed. Methods MEDLINE (1966 to April 2005),EMBASE (1966 to April 2005), The Cochrane Library (Issue 1, 2005) and CBMdisc (1979 to April 2005) were searched for randomized controlled trials (RCTs). Data were extracted by two reviewers using a designed extraction form. The quality of included RCTs was critically assessed. RevMan 4.2 software was used for data analysis. Results Four RCTs were included. The results of meta-analysis showed that small dose of radioisotopes couldn’t control metastatic pain in short term(2 months) with relative risk (RR) 1.13, 95%confidence interval (CI) 0.34 to 3.76, but large dose can significantly control metastatic pain in medium term(6 month) with RR 1.90, 95％CI 1.23 to 2.92; no evidence was available to assess long term(≥12 months) effects. No study provided data on quality of life, mortality, bone metastatic complications (hypercalcaemia, bone fracture) and analgesic use etc. Leukocytopenia and thrombocytopenia were secondary effects associated with the administration of radioisotopes. The incidences of leukocytopenia and thrombocytopenia were significantly greater in patients treated by radioisotopes with RR 8.28, 95％CI 2.24 to 30.67, and RR 3.70, 95％CI 1.59 to 9.04, respectively. Conclusions There is some evidence indicating that large dose of radioisotopes can relieve metastatic bone pain over one to six months, but adverse effects, particularly leukocytopenia and thrombocytopenia, have also been experienced.
ObjectiveTo explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies.MethodsWe retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation.ResultsOf the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33).ConclusionWhen we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.
ObjectivesTo systematically review the value of cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) in the diagnosis of bone metastases of lung cancer.MethodsThe Cochrane Library, PubMed, EMbase, WanFang Data and CBM databases were electronically searched to collect studies on ICTP in the diagnosis of lung cancer bone metastases from inception to November 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 8 studies involving 781 patients were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of summary receiver operating characteristics were 71% (95%CI 0.65 to 0.76), 80% (95%CI 0.76 to 0.84), 3.79 (95%CI 2.31 to 6.21), 0.35 (95%CI 0.25 to 0.49), 14.67 (95%CI 6.99 to 30.81) and 0.860 3, respectively.ConclusionsICTP cooperate with imaging tests may be accurate and practical in diagnosis of bone metastases of lung cancer. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
Objective To systemically review the efficacy and safety of strontium chloride for bone metastases from prostate cancer. Methods PubMed, The Cochrane Library, EMbase, VIP, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) about strontium chloride for bone metastases from prostate cancer from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 7 RCTs involving 1 532 patients were included. The results of meta-analysis showed that strontium chloride was superior to placebo in the rate of pain relief (RR=1.79, 95%CI 1.35 to 2.37, P<0.000 1), but more likely to cause slight leucopenia (Peto OR=5.02, 95%CI 1.49 to 16.95,P=0.009). However, no significant difference was found in overall survival time between two groups (RR=0.87, 95%CI 0.58 to 1.30, P=0.49). In addition, strontium chloride was superior to radiotherapy in rate of bone pain relief (RR=1.28, 95%CI 1.12 to 1.47, P=0.0004), but it would cause thrombocy (Peto OR=2.61, 95%CI 1.04 to 6.57, P=0.04). Conclusion Current evidence shows that the strontium chloride is superior to placebo in the rate of pain relief, but it will cause slight leucopenia. The strontium chloride is superior to radiotherapy in rate of bone pain relief. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.