结直肠癌骨转移的临床特点及治疗(附104例)

目的:探讨结直肠癌骨转移的临床特点,提高结直肠癌骨转移诊疗水平.方法:通过对中国医科大学附属盛京医院2012年1月1日至2015年1月1日收治的104例结直肠癌骨转移患者资料进行回顾性分析,分析其临床特征,绘制生存曲线,总结诊疗规律.结果:2012年1月1日至2015年1月1日期间我院共收治结直肠癌骨转移患者104例,占同期结直肠癌患者的10.0%(104/1 038),其中结肠癌骨转移38例,直肠癌骨转移66例.多发骨转移60例(57.7%),单发骨转移44例(42.3%),常见转移部位依次为腰椎(38.5%)、骶骨(32.7%)、胸椎(30.8%)、肋骨(26.9%)、四肢骨(19.2%)、肩胛骨(3.8%)、颌面骨(1.9%).共有74例患者合并有远处脏器转移(71.2%),≥2处者46例,肺脏42例,肝脏40例,腹膜后淋巴结14例,腹股沟淋巴结6例,肾上腺4例,脑2例.确诊骨转移的中位时间为(26.1±3.3)个月.从确诊骨转移之日算起,中位生存期为(22.5±4.0)个月.结论:结直肠癌骨转移患者多合并远处脏器转移;直肠癌比结肠癌更易发生骨转移.     

结直肠癌骨转移患者的临床特点和预后分析

摘 要：［目的］ 分析结直肠癌骨转移患者的临床特点。［方法］ 回顾性分析86例结直肠癌伴骨转移患者的临床资料。［结果］ 86例骨转移结直肠癌患者占同期治疗结直肠癌患者的4.3%;86例骨转移患者中结肠癌占3.3%,直肠癌占5.3%,具有统计学差异（χ2=4.45,P<0.05）;发生骨转移合并肺转移占65.1％;未发生骨转移患者肺转移占12.7%,两者具有统计学差异（χ2=17.7,P<0.01）。除1例(1.2％)患者仅有骨转移之外,其余85例(98.8％)患者均合并其他部位转移。单因素分析中,ECOG评分、骨转移时间、骨转移灶数目及其他脏器的转移与结直肠癌骨转移患者的预后有关(P<0.05);多因素分析中,仅骨转移时间和其他脏器转移是影响结直肠癌骨转移患者预后的独立因素(P<0.05)。［结论］结直肠癌骨转移中,直肠癌所占比例高于结肠癌,结直肠癌骨转移发生可能与肿瘤部位有关;结直肠癌骨转移与肺转移具有一定的相关性。     

156例结直肠癌骨转移临床病理特征及预后分析

目的：探讨结直肠癌骨转移患者的相关临床病理学特点，分析结直肠癌骨转移患者预后的相关因素。方法：选取 2010 年 1 月至 2017 年 7 月在四川大学华西医院诊治的 156 例结直肠癌骨转移患者，收集临床病理及预后资料进行回顾性分析，单因素生存分析采用 Kaplan-Meier 法和 Log-rank 检验以及 COX 回归，多因素生存分析采用 COX 回归模型。结果：156 例患者中直肠癌 108 例（69.2%），结肠癌 48 例（30.8%）；同时性骨转移 61 例（39.1%），异时性骨转移 95 例（60.9%）。确诊肠癌至出现骨转移的中位时间 365 天，其中异时性骨转移患者发生骨转移中位时间为 784 天。多发骨转移 113 例（72.4%），单发骨转移 43 例（27.6%）。仅 30 例（19.2%）以骨转移为唯一远处癌转移灶，其余 126 例（80.8%）患者均存在骨以外的其他转移病灶，其中合并肺转移 92 例（59.0%），合并肝转移 77 例（49.4%）。95 例异时性骨转移患者中 60 例骨转移都不是初发，其中 46 例继发于肺转移。与同时性骨转移相比，癌胚抗原升高、骨痛、肺转移、淋巴结阴性、病理类型中 - 高分化的患者在异时性骨转移中更常见。结直肠癌发生骨转移后中位生存时间 11 个月。Log-rank 单因素分析发现：骨转移患者中位总生存时间与淋巴结是否阳性、CA199 水平、血钙浓度，碱性磷酸酶（alkaline phosphatase，ALP）水平、是否为初发骨转移、骨转移个数、有无骨相关事件、原发灶是否切除及是否合并肝转移有关。单因素 COX 回归分析显示：骨转移患者中位总生存时间与淋巴结是否阳性、血钙浓度、ALP 水平、骨转移个数、合并肝转移有关。多因素分析结果表明：ALP 水平升高、非初发骨转移是结直肠癌骨转移患者独立预后危险因素。结论：结直肠癌骨转移以异时性骨转移常见，异时性骨转移仅少部分为初发转移。结直肠癌骨转移多合并其他远处转移灶，异时性骨转移合并肺转移显著高于同时性骨转移。结直肠癌骨转移总体预后差，ALP 水平升高、非初发骨转移可能是其独立的不良预后因素。     

104例结直肠癌骨转移患者的临床特征及预后

目的 探讨结直肠癌骨转移患者的临床特征及预后.方法 回顾性分析104例结直肠癌骨转移患者的临床资料.结果 104例患者中,单发骨转移45例(43.3％),多发骨转移59例(56.7％).骨转移最常见的部位为骨盆(46.1％)、胸椎(41.3％)、腰椎(40.4％)、骶椎(29.8％)和肋骨(29.8％).104例患者中,仅2例患者以骨转移为唯一远处转移灶,102例(98.1％)患者均合并其他部位转移.从确诊结直肠癌至骨转移的中位时间为16个月.从骨转移至首次发生骨相关事件的中位时间为1个月.骨转移灶放疗、严重骨痛、病理性骨折的发生率分别为44.2％、15.4％和9.6％.发生骨转移后患者的中位生存时间为10.0个月,首次发生骨相关事件后患者的中位生存时间为8.5个月.单因素分析中,ECOG评分、化疗和双膦酸盐治疗与结直肠癌骨转移患者的预后有关(均P＜0.05).多因素分析中,仅ECOG评分和化疗是影响结直肠癌骨转移患者预后的独立因素(均P＜0.05).结论 结直肠癌骨转移患者的预后较差,化疗和双膦酸盐治疗可能给患者带来生存获益.     

肝转移性癌76例诊治体会

 本文总结了我院1984年至1994年收治的肝转移性癌76例。31例消化道癌肝转移后的平均生存期为4个月。45例非消化道癌肝转移后的平均生存期为9.6个月。表明肝转移性癌治疗效果差，在结直肠癌，是术后的主要死亡原因。3例行同步肝叶切除的结直肠癌患者的平均生存期为18个月，提示在结直肠癌手术中应加强对肝转移的治疗，以延长平均生存期。     

结直肠癌根治术患者骨转移临床病理特征及其相关危险因素分析

目的 分析结直肠癌(CC)根治术骨转移患者临床病理特征及其相关危险因素。方法 选择285例CC患者，均采用结直肠癌根治术治疗，术后随访2年，分析骨转移临床病理特征，收集患者临床及病理资料。统计骨转移发生情况及临床病理特征，分析骨转移发生的相关危险因素。结果 285例行结直肠癌根治术治疗的CC患者术后发生骨转移20例，骨转移发生率7.02%;其中结肠癌7例，直肠癌13例；Ⅰ+Ⅱ期3例，Ⅲ+Ⅳ期17例；低分化4例，中分化11例，高分化5例；单发6例，多发14例；颅骨转移、四肢转移各1例，躯干转移2例，脊柱转移3例，骨盆转移13例；成骨性1例，溶骨性14例，混合性5例；合并肝转移6例，合并肺转移12例，合并胰腺、脑转移各1例；骨转移组直肠癌、Ⅲ+Ⅳ期、淋巴结受累、合并肺转移、术后未进行化疗占比高于未发生骨转移组，有统计学差异(P<0.05);Logistic回归分析显示，直肠癌、Ⅲ+Ⅳ期、淋巴结受累、合并肺转移、术后未进行化疗是患者骨转移发生的影响因素(P<0.05且OR≥1)。结论 结直肠癌根治术患者骨转移多见于中晚期CC患者，且多发生于中轴骨，骨性改变以溶骨性病变最为常见，且...     

三种抗血管生成药物治疗晚期结直肠癌研究进展

血管生成在结直肠癌的发生、发展中发挥重要作用。靶向血管内皮生成因子信号通路的药物治疗晚期结直肠癌获得了重要的生存改善。在化疗基础上联合贝伐珠单抗一线、二线和跨线治疗晚期结直肠癌可进一步延长生存期。阿柏西普联合含伊立替康的化疗方案治疗晚期结直肠癌延长了生存期。对抵抗所有化疗药物的晚期结直肠癌患者使用瑞格非尼后仍延长了生存期。这些抗血管生成药物为晚期结直肠癌患者带来了生存获益,并拥有良好的安全性,可以和化疗药物联合用于晚期结直肠癌患者的的治疗。     

结直肠癌伴肝转移91例患者的多因素预后分析

目的：探讨结直肠癌同时性肝转移患者的预后相关因素。方法：采用多因素回归分析方法回顾性分析了91例结直肠癌同时性肝转移患者的生存因素。结果：91例结直肠癌同时性肝转移的患者中位生存期为16.8个月,1年生存率为61.54%,3年生存率为14.79%,5年生存率为8.87%。单因素分析显示原发灶手术、肝转移分期、介入治疗、放射治疗、物理治疗、化疗和新药使用与患者的生存期显著相关;多因素分析显示,肝转移分期、原发病灶手术切除、介入治疗、物理治疗对患者的预后有显著影响,是结直肠癌同时性肝转移影响预后的主要因素。结论：对于结直肠癌同时性肝转移的患者应积极切除原发病灶,进行介入、物理等综合治疗可以提高患者的生存期。     

碳离子治疗结直肠癌的基础与临床研究进展

结直肠癌是临床常见的恶性肿瘤, 放射治疗作为结直肠癌的主要治疗方法, 对肿瘤进展有较好的抑制作用。近年来, 碳离子因其良好的物理学及生物学优势, 在对结直肠癌局部复发或者远处转移的治疗中, 表现出比传统放疗更好的临床效果。本文主要回顾了近年来碳离子治疗结直肠癌复发的相关基础与临床研究, 以期为预防和减少结直肠癌患者放疗后不良反应及延长患者生存期提供理论依据。     

结直肠癌骨转移的诊断与综合治疗

结直肠癌多转移至肝,其次是肺、骨、脑等部位。Nozue[1]等人回顾分析了928例结直肠癌患者,其中12例被确诊为骨转移,只占其统计的全部骨转移患者的1.3%。近年来,由于癌症综合治疗模式的合理应用,患者生命期延长,因此结直肠癌骨和脑转移较以前报道多。Sundermeyer[2]回顾了1020例     

原发性肝癌骨转移19例临床分析

目的提高原发性肝癌骨转移的诊治水平。方法回顾性分析19例肝癌骨转移的诊治方法及疗效。结果肝癌发生骨转移后的中位生存期仅为4,5个月,放疗对骨转移瘤引起的疼痛有较好的缓解作用。结论肝癌骨转移的预后较差,尚无特效治疗,强调支持对症的重要。早期诊断骨转移灶,严格掌握手术适应症,有缓解症状、提高生活质量的积极意义。     

Cancer of the prostate: value of bone scintigraphy. Point of view

Radionuclide bone scanning carried out with technetium radiopharmaceutics detects almost all prostatic carcinoma osseous metastases. It is easy to recognize focal areas of increased tracer uptake or a diffuse increased uptake, and the test provides a synthetic view of the entire skeleton. Complementary bone radiographs are necessary if the diagnosis remains doubtful, if mechanical complications are searched and if there is a post-radiotherapeutic decrease of the tracer uptake. A bone scan is necessary before the radical treatment of the primary tumour, in order to rule out the possibility of bone metastases. The initial bone scan has also a pronostic value. However, in the follow-up of initially non-metastatic patients, serial bone scans should not be realized when clinical symptoms or biological abnormalities lack. Bone scintigraphy is also useful to monitor the course of bone metastases under treatment, especially when the value of new therapeutic agents is investigated.     

The skeletal metastatic complications of renal cell carcinoma.

Of the 103 patients with advanced renal cell carcinoma 31 (30%) developed symptomatic radiologically confirmed skeletal metastases. These were typically lytic, predominantly affecting the axial skeleton and associated with considerable skeletal morbidity. Solitary bone lesions occurred in 14 (45%) of patients. The median survival of patients with bone metastases was 12 months. Hypercalcaemia was common in patients both with (29%) and without (44%) bone metastases. The number and rate of skeletal related events was similar to that seen from bone metastases from breast cancer. It would therefore be appropriate to evaluate the effectiveness of bisphosphonate treatment for reducing skeletal morbidity in advanced renal cell cancer with bone metastases.     

18FDG-PET对大肠癌分期、再分期诊断的价值

目的:评价18FDG-PET(18氟标记脱氧葡萄糖-正电子发射断层扫描)对大肠癌分期及术后再分期的价值。方法:对24例经肠镜检查初步诊断为直肠、结肠癌的患者行全身18FDG-PET检查,并在1～2W内完成手术及病理诊断。大肠癌术后18FDG-PET随访56例。结果:24例病理证实为大肠癌,23例局部18FDG摄取增高,SUVmax=7.09±3.26,2.98～12.2(SUV,Standarduptakevalue)。18FDG-PET对于肿瘤原发病灶诊断准确率为95%(23/24)。假阴性1例。单纯局部(主要为第1站)淋巴结转移8例(灵敏度8/16,50%),远处转移8例。改变33%(8/24)的患者治疗方案。56例随访病例中30例PET显示阴性,其中5例随访2年后复发,准确率83.4%。26例发现局部和/或多发转移,其中颈部淋巴结转移8例;肺及纵隔转移4例;肝转移7例;腹腔淋巴结转移11例;吻合口局部复发12例,骨转移11例。结论:18FDG-PET对大肠癌的分期和术后的再分期诊断有较高价值。     

Outcome of surgical treatment for bone metastases caused by colorectal cancer

BackgroundCancer of the lower intestinal tract, although relatively common, rarely metastasizes to the skeleton. The treatment of metastatic bone disease due to colorectal cancer has thus been poorly described and treatment decisions are therefore difficult. The aim of this study was to describe the outcome of orthopedic surgery in patients with pathological fractures from colorectal cancer and investigate factors that correlate with patient survival, since it influences treatment decisions.MethodsRetrospective review of data collected in a prospectively collected database. 36 patients (38 fractures) who underwent surgery between 2000 and 2019 for metastatic bone disease caused by colorectal cancer were included.ResultsMost metastases were localized in the axial skeleton and 33/36 patients already had visceral metastases. Patients with pathological fractures from colorectal cancer had poor prognosis, with only 5/36 surviving more than 1 year, median survival being 3 months. Patients presenting with a single skeletal metastasis had a superior overall survival (P≤0.001). Post-operative complications were common, noted in 11 patients, and the surgical failure rate was considerable.ConclusionsAlthough relatively rare, bone metastases should be suspected in patients with colorectal cancer presenting with signs and symptoms of spinal cord compression or skeletal pain. In this case, the presence of a solitary skeletal lesion is a favorable prognostic sign. Awareness for local complications after surgery should be high.     

Risk of complications from bone metastases in breast cancer. implications for management

A retrospective analysis of 859 patients who developed bone metastases from breast cancer between 1975 and 1991 was performed in order to identify factors that predict for complications from skeletal disease. The patients were divided into four groups based on the sites of disease at diagnosis of skeletal metastases: bone disease only; bone and soft tissue disease; bone and pleuro-pulmonary disease; bone and liver disease. Patients with metastatic disease confined to the skeleton were most likely to develop a pathological fracture. The time to long bone fracture was similar for all groups, but the least number of such fractures occurred in patients with bone and liver metastases since their survival was shortest (median: 5.5 months; P<0.001). Patients with bone metastases only were most likely to require radiotherapy to painful osseous deposits (P=0.0001) and most rapidly developed spinal cord compression (P=0.01, data not shown). The results suggest that patients with disease confined to the skeleton at the diagnosis of bone metastases are most likely to develop skeletal-related complications from advanced breast cancer. Such patients may benefit most from treatment with bisphosphonates.     

Humoral hypercalcemia in patients with colorectal carcinoma: report of two cases and review of the literature

BACKGROUND: Humoral hypercalcemia rarely is associated with colorectal carcinoma; to the authors' knowledge only nine cases have been reported to date. METHODS: Two cases of advanced colorectal carcinoma with humoral hypercalcemia of malignancy (HHM) are presented. RESULTS: The two patients had severe hypercalcemia without bone metastases. The diagnosis of HHM was based on findings of hypercalcemia, hypophosphoremia, elevated serum parathyroid hormone-related peptide (PTHrP), and positive tumor immunoreactivity to monoclonal PTHrP antiserum. One patient had a colonic adenocarcinoma with a neuroendocrine component and the other patient had rectal adenocarcinoma. Immunoreactive PTHrP was found in both tumor components. Bisphosphonate treatment normalized the hypercalcemia within a few days but it recurred in the patients 2 weeks and 3 weeks later, respectively. The prognosis was extremely poor. CONCLUSIONS: To the authors' knowledge the two cases presented in the current study are the first to be reported with HHM-associated colorectal carcinoma with positive tumor immunoreactivity to PTHrP monoclonal antiserum.     

肝细胞性肝癌骨转移的诊疗进展与预后因素研究

随着临床诊治水平的不断进步，肝细胞性肝癌（hepatocellular carcinoma，HCC）患者的总生存时间获得延长，但是HCC骨转移发生率则显著升高，HCC骨转移的筛查与诊治已成为全球性热点与难点问题。明确HCC骨转移的致病机制有助于临床肿瘤筛查及诊疗手段的提高，血管形成和上皮-间质转化（epithelial mesenchymal transition，EMT）是HCC骨转移的主要致病机制，骨微环境使得HCC骨转移持续发生。明确HCC骨转移的预后因素有利于对此类患者进行早期干预以延长患者总生存期，但目前尚未就HCC骨转移患者的治疗策略达成共识。本文就HCC骨转移分子病理学致病机制的研究进展进行综述，为早期筛查、精准诊断和个体化治疗提供依据。      

99Tcm-亚甲基二膦酸盐全身骨显像评价原发性肺癌骨转移的特征

目的 探讨原发性肺癌骨转移病灶的影像学特征.方法 对258例病理确诊的肺癌患者行99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨显像,分析各部位骨骼的骨转移率、病灶构成和病灶的形态特征等.结果 全组258例肺癌患者中,存在骨转移142例,骨转移率为55.0%,其中中轴骨的骨转移率为49.6%,四肢骨为36.0%;中轴躯干骨为48.4%,四肢带骨为31.4%;肋骨、胸椎、髂骨和腰椎骨的转移率较高,均>20%.共检出骨转移病灶1252个,其中位于身体左侧406个,居中387个,右侧459个,左右两侧病灶数的差异无统计学意义(χ2=3.3,P=0.072);浓聚病灶1224个(97.8%),混合性病灶26个(2.1%),稀疏病灶2个(0.2%).骨转移病灶按形态归类后共1133个,其中点状病灶810个(71.5%),团状病灶159个(14.0%),条状病灶108个(9.5%),片状病灶56个(4.9%).1-3个病灶的累积骨转移率为28.7%,随着病灶数的增加,骨转移率逐渐降低.早期骨转移病灶分布无明确规律,晚期骨转移病灶呈随机性广泛分布.结论 肺癌易发生骨转移,骨转移早期病例临床最为常见;骨转移好发于中轴躯干骨和四肢带骨,以放射性浓聚病灶为主,以点状为早期病灶形态;早期骨转移病灶分布无明确规律,晚期骨转移病灶呈随机性广泛分布,并且常呈多发性多形态病灶并存的特征.