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ABSTRACT Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Bone Neoplasms/secondary , Thyroid Neoplasms/pathology , Time Factors , Bone Neoplasms/mortality , Thyroid Neoplasms/mortality , Retrospective Studies , Kaplan-Meier Estimate , Neoplasm StagingABSTRACT
La presencia de metástasis a distancia en el cáncer diferenciado de tiroides es un hecho infrecuente que ocurre en menos del 10% de los pacientes. Cuando sucede, la supervivencia a 10 años disminuye significativamente. La curación es el objetivo primario, pero dado que 2 tercios de los tumores metastásicos se volverán radiorrefractarios en su evolución, la finalidad terapéutica es estabilizar la enfermedad y tratar sus síntomas. En la última década, el manejo de estos pacientes cambió radicalmente con el advenimiento de las terapias con blancos moleculares. El objetivo de esta revisión es describir las características de los pacientes con cáncer diferenciado de tiroides que presenten metástasis a distancia, la supervivencia global, los métodos diagnósticos utilizados, y los tratamientos locales y sistémicos disponibles.
Distant metastases occur in less than 10% of patients with differentiated thyroid carcinoma. In these patients, overall survival at 10 years is considerably reduced. Whereas cure is the initial goal of treatment, stabilisation of the disease and management of symptoms have become the primary objective in many patients with persistent radio-iodine refractory progressive disease. In the last decade, several targeted therapies have shown encouraging results in patients with advanced disease. The objective of this review is to describe the characteristics, diagnosis, overall survival, and the local and systemic available treatments for patients with distant metastases from differentiated thyroid cancer.
Subject(s)
Humans , Male , Female , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/therapy , Radiotherapy , Thyroid Neoplasms/complications , Thyroid Neoplasms/mortality , Drug Therapy , Iodine/therapeutic useABSTRACT
Phyllodes tumours (PTs) of the breast are uncommon fibroepithelial neoplasms, comprising 0.3 1.0% of all primary breast malignancies in Western countries, but accounting for a higher proportion of primary breast tumours in Asian countries. They are graded as benign, borderline or malignant based on the World Health Organisation (WHO) classification, according to a constellation of 5 histologic parameters. While most PTs carry a good prognosis, malignant and occasionally borderline PTs have the potential to metastasize to distant sites. Although events of distant metastasis are few, the prognosis for such patients is dismal, as they are often unresponsive to chemotherapy with high mortality. This review seeks to provide an overview of this rare but important phenomenon of distant metastases in PTs of the breast (AU)
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Humans , Male , Female , Prognosis , Breast Neoplasms , Review Literature as Topic , Neoplasms, Fibroepithelial , Phyllodes Tumor , Neoplasm MetastasisABSTRACT
[Abstract ] Objective Nephroblastoma is one of the solid malignancies with fair prognosis in children .The lungs, liver, and bones are the common organs for distant metastasis of the tumor and important factors influencing the therapeutic effects as well .This study was to investigate the clinical characteristics and prognosis of nephroblastoma with distant metastasis in children . Methods We retrospectively analyzed the clinical characteristics , pathological features , and prognosis of 9 cases of nephroblastoma with distant metastasis treated in Nanjing Children Hospital from September 2011 to May 2015 . Results The patients presented with abdominal masses, distention and pain at preliminary diagnosis and confirmed with nephroblastoma , with pulmonary metastasis in 7 cases, liver metastasis in 1, and lung and liver metastases in the other .All were treated by surgery, radiotherapy, and chemotherapy and followed up for a median time of 34 months.By the end of the follow-up, 1 patient died of recurrence , 1 was undergoing chemotherapy , and the other 7 were being recovered, including complete disappearance of lung metastasis in 4, obvious reduction or calcification of lung metastasis in 2, evident disappearance of liver metastasis in 1, but relapse in none. Conclusion Lung and liver are common sites of nephroblastoma metastasis in children .As for the treatment of the disease , relatively good results can be achieved by radiotherapy , chemotherapy , and reoperation .
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Objective To investigate the relationship between dyslipidemia and distant metastases in pa-tients with hormone receptor( HR) negative breast cancer,and to explore the impact of blood lipid change during chemotherapy on clinical response.Methods We collected the complete clinicopathological data and fasting blood lipid in 154 patients with HR negative breast cancer.The secondary blood lipid level were measured on day14 after two cycles of chemotherapy in patients with distant metastases.Single factor chi -square test was choosen to analyze the relationship between clinicopathological characteristics,including baseline lipid level,and distant metastases,then independent risk factor for distant metastases were evaluated by logistic regression model. Data about altered blood lipid and clinical response analysis were performed using paired t-test pre-or post-chemotherapy.Results Our results from single chi-square test showed that distant metastasis from breast canc-er was significantly associated with tumor size,local lymph node metastases,grade,higher total cholesterol( TC) , higher triglycerides(TG)and higher low-density lipoprotein(LDL)(P<0.05).For distant metastases,inde-pendent risk factors were tumor size(OR=1.563),local lymph node metastases(OR=1.983),higher TC(OR=1.502),higher TG(OR=1.877).Decreased trend of TC,TG and LDL and increased trend of HDL were showed in disease control( PR+SD) group,and TG had significantly tend in objective response( PR) group.Conclusion Hyperlipidmia is significantly associated with distant metastases in patients with HR negative breast cancer,andblood lipid levels decrease with effective anti -tumor chemotherapy.Dynamic monitoring of blood lipid levelscould be a candidate surrogate biomarker for outcome prediction and distant metastases in patients with HR negativebreast cancer.
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BACKGROUND/AIMS: Follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC) of the thyroid are relatively uncommon thyroid malignancies in iodine-sufficient areas. In this study we evaluated the clinical behavior, prognostic factors and treatment outcomes of FTC and HCC in Korea. METHODS: This multicenter study included 483 patients with FTC and 80 patients with HCC who underwent an initial surgery between 1995 and 2006 in one of the four tertiary referral hospitals in Korea. We evaluated clinicopathological factors associated with distant metastases and recurrence during a median of 6 years of follow-up. RESULTS: HCC patients were significantly older (49 years vs. 43 years; p < 0.001) and had more lymphovascular invasions (22% vs. 14%; p = 0.03) compared with FTC patients. Distant metastases were confirmed in 40 patients (8%) in the FTC group and in two patients (3%) in the HCC group (p = 0.07). Distant metastases were significantly associated with older age, widely invasive cancer and extrathyroidal invasion. Only 14 patients (3%) had recurrent disease and there was no significant difference between FTC and HCC groups (p = 0.38). Recurrence was associated with larger tumor size and cervical lymph node metastasis. CONCLUSIONS: HCC patients were older and had more lymphovascular invasions than FTC patients. However, FTC and HCC patients had similar initial clinicopathological features. Older age, wide invasiveness and extrathyroidal invasion were independent risk factors for predicting distant metastases in FTC and HCC patients.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Adenocarcinoma, Follicular/epidemiology , Age Factors , Diet , Iodine , Lymphatic Metastasis , Neoplasm Recurrence, Local , Nutritional Status , Republic of Korea/epidemiology , Retrospective Studies , Risk Factors , Tertiary Care Centers , Thyroid Neoplasms/epidemiology , Thyroidectomy , Time Factors , Treatment OutcomeABSTRACT
Objective: To compare the clinical characteristics of patients with Gleason score 3+4 and Gleason score 4+3 after radical prostatectomy for prostate cancer. Methods: The clinical records of patients who underwent radical retropubic prostatectomy in our hospital from 2001 to 2006 were retrospectively analyzed. Thirty-seven patients with a Gleason score of 7 after operation were divided into 2 groups, Gleason score 3+4 group and Gleason score 4+3 group, according to major grading. The patients were followed up for biochemical recurrence and distant metastases. Radioimmunoassay was used to detect the serum prostate-specific antigen (PSA) level. Kaplan-Meier method was used to compare the progression-free survival curves and Cox regression model was used to analyze the independent factors influencing the disease progression. Results: The rates of extraprostatic extension at radical prostatectomy were not significantly different between 3+4 and 4+3 groups (21.1% vs 33.3%, P=0.462). The non-progression survival time of 3+4 group was markedly longer than that of 4+3 group (P= 0.030). Cox regression model showed that Gleason primary grade was an independent factor o[prognosis (P=0.033). 4+3 group had a higher risk for biochemical recurrence. Conclusion: Prostate cancers of Gleason score 7 with different grades have different biologic behaviors. The prognoses of patients in 3+4 group and 4+3 group are different after operation. It is quite feasible to further classify the patients with Gleason 7 according to major grades.
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El Dermatofibrosarcoma es una neoplasia relativamente rara, de bajo crecimiento, malignidad intermedia, con un alto índice de recurrencia local; siendo las metástasis a distancia extremadamente raras, presentándose sólo en 1% a 5% de los casos, luego de múltiples recidivas locales. Se presentó una paciente con un Dermatofibrosarcoma protuberans en el glúteo derecho, operada, quien posteriormente desarrolló metástasis óseas y pulmonares. Se expone el cuadro clínico y la terapéutica efectuada. Nos propusimos revisar y analizar la evidencia científica disponible en la literatura mundial para determinar las manifestaciones clínicas más frecuentes del Dermatofibrosarcoma, así como los medios diagnósticos más empleados en la actualidad y su potencial metastático.
Dermatofibrosarcoma protuberans is a relatively uncommon soft tissue neoplasm with intermediate-to-low grade malignancy that rarely metastasizes (1-5%) but has a high incidence of local recurrence. A case of Dermatofibrosarcoma protuberans in right gluteus was presented, and after resection of the tumor a lung and bone metastases was discovered. The clinical form of presentation and the treatment are described. We proposed to review and analyze the scientific evidence available in the world literature for determining clinical manifestations most frequent in Dermatofibrosarcoma protuberans as well as diagnostic means widely used in current times.
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Humans , Female , Clinical Diagnosis , Dermatofibrosarcoma , NeoplasmsABSTRACT
Objective:To compare the clinical characteristics of patients with Gleason score 3+4 and Gleason score 4+3 after radical prostatectomy for prostate cancer.Methods: The clinical records of patients who underwent radical retropubic prostatectomy in our hospital from 2001 to 2006 were retrospectively analyzed.Thirty-seven patients with a Gleason score of 7 after operation were divided into 2 groups,Gleason score 3+4 group and Gleason score 4+3 group,according to major grading.The patients were followed up for biochemical recurrence and distant metastases.Radioimmunoassay was used to detect the serum prostate-specific antigen(PSA) level.Kaplan-Meier method was used to compare the progression-free survival curves and Cox regression model was used to analyze the independent factors influencing the disease progression.Results: The rates of extraprostatic extension at radical prostatectomy were not significantly different between 3+4 and 4+3 groups(21.1% vs 33.3%,P=0.462).The non-progression survival time of 3+4 group was markedly longer than that of 4+3 group(P=0.030).Cox regression model showed that Gleason primary grade was an independent factor of prognosis(P=0.033).4+ 3 group had a higher risk for biochemical recurrence.Conclusion: Prostate cancers of Gleason score 7 with different grades have different biologic behaviors.The prognoses of patients in 3+4 group and 4+3 group are different after operation.It is quite feasible to further classify the patients with Gleason 7 according to major grades.
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BACKGROUND AND OBJECTIVES: There are many failed cases with distant metastases (DMs) of head and neck cancer. In such cases, patients usually have poor prognosis, with a median duration of survival between 4 and 6 months. To find out the correlation between the general clinical aspects and distant metastases in patients with head and neck cancer, we analyzed our previous experiences. MATERIALS AND METHOD: We reviewed records retrospectively in 41 of 460 patients with head and neck cancers from 1986 to 1995. DMs were confirmed with X-ray, CT, MRI, liver scan, FNAC, PCNA, and biopsy. We used the staging system of American Joint Committee on Cancer. RESULTS: 1) Clinically manifested DMs were found in 8.9% (41/460) of patients. 2) DMs were frequently observed in the oropharynx (13.8%), oral cavity (11.4%), and larynx (10.3%) cancer. 3) The lung is the most common site of DMs for head and neck cancer. Liver and bone are the only other sites of DMs that are commonly clinically diagnosed. 4) DMs usually occur within 2 years of the initial diagnosis. 5) The incidence of DMs was significantly higher in the advanced T, N stages and clinical stage than in the early T, N stages and clinical stage (p<0.05). CONCLUSION: The results of this study suggest that the advanced T, N stages and clinical stage may be some of the most critical factors influencing the eventual development of DMs.
Subject(s)
Humans , Biopsy , Diagnosis , Head and Neck Neoplasms , Head , Incidence , Joints , Larynx , Liver , Lung , Magnetic Resonance Imaging , Mouth , Neck , Neoplasm Metastasis , Oropharynx , Prognosis , Proliferating Cell Nuclear Antigen , Retrospective StudiesABSTRACT
Objective To study the relationship between the expression of nm23- H1 gene product and early distant metastases in nasopharyngeal carcinoma (NPC). Methods The S- P immunohistochemical method was used to detect the expression of nm23- H1 in 95 cases of NPC. Results The positive rate of nm23- H1 was 47.4 % (45/95). The positive rate of nm23- H1 in early distant metastases group (26.7 %) was much lower than those without distant metastases group (60.0 %) (P
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One hundred and thirty five patients with carcinoma of the nasopharyx were treated by radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University between August 1977 and July 1987. Of the 30 patients omitted: 8 had distant metastases at initial diagnosis or during radiotherapy; 18 patients refused or did not received a full course of radiation therapy, and four had not been confirmed histologically. The remaining 105 patients were analyzed to determine the incidence and patter of distant metastases. Diagnosis of distant metastases was made based on clinical signs and radiography, even though histologic confirmation was not made. Twenty-six patients developed distant metastases after definite irradiation of nasopharyx and neck, an incidence rate of 24.8%. The common sites of distant metastases were, in descending order, bone, lung, liver, and brain. There was a strong correlation between Ho's N stage and distant metastases rate. But sex, age, histologic subtype (squamous cell and undifferentiated cell), AJC T and N stage, treatment modalities (radiotherapy alone and radiotherapy combined with chemotherapy) were not significant. Of those patients who developed distant metastases, 80.8% were discovered within 2 years of their radical radiotherapy. The prognosis for nasopharyngeal carcinoma patients developing distant metastases was poor: median survival was nine months and 80% of those patients died within two years of the initial diagnosis of distant metastasis.