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Bone metastases of unknown origin: epidemiology and principles of management

機(jī)譯：未知來(lái)源的骨轉(zhuǎn)移：流行病學(xué)和管理原則

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AbstractMetastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin–eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4–8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible.
機(jī)譯：摘要轉(zhuǎn)移瘤是涉及骨骼的最常見(jiàn)的惡性腫瘤。乳腺癌，前列腺癌，肺癌和甲狀腺癌是原發(fā)癌的主要部位。然而，多達(dá)30％的患者出現(xiàn)骨來(lái)源不明的骨轉(zhuǎn)移，盡管有詳盡的病史，體格檢查，適當(dāng)?shù)膶?shí)驗(yàn)室測(cè)試和現(xiàn)代成像技術(shù)（CT，MRI），但在診斷時(shí)仍無(wú)法確定原發(fā)性腫瘤的部位， 寵物）。有時(shí)，僅對(duì)活檢的骨標(biāo)本進(jìn)行廣泛的組織病理學(xué)檢查才能提示原發(fā)性惡性腫瘤。在其他時(shí)候，骨病變可能具有如此高度未分化的組織學(xué)外觀，以致無(wú)法對(duì)常規(guī)蘇木精-伊紅染色的切片進(jìn)行精確的病理分類。作者回顧了相關(guān)文獻(xiàn)，試圖調(diào)查在隱匿性癌的骨轉(zhuǎn)移患者中最終鑒定出的組織學(xué)原發(fā)的流行病學(xué)，并提出了治療和治療隱匿性癌的骨轉(zhuǎn)移的策略。肺，肝，胰腺和胃腸道是原發(fā)性隱匿性腫瘤的常見(jiàn)部位。腺癌是主要的組織學(xué)類型，占所有病例的70％，而未分化癌占20％。在過(guò)去的30年中，肺癌是導(dǎo)致骨轉(zhuǎn)移的主要隱匿原因，預(yù)后較差，平均生存期為4-8個(gè)月。大多數(shù)相關(guān)文獻(xiàn)集中在對(duì)標(biāo)準(zhǔn)化診斷檢查的需求上，因?yàn)閮H在骨病變?yōu)閱伟l(fā)和/或隱匿性原發(fā)灶預(yù)后良好時(shí)，才應(yīng)積極進(jìn)行骨病變的手術(shù)。在這些情況下，對(duì)原發(fā)腫瘤的識(shí)別可能很重要，需要特殊的診斷工作。但是，在大多數(shù)情況下，即使經(jīng)過(guò)尸檢，主部位仍是未知的。因此，整形外科手術(shù)在預(yù)防或穩(wěn)定病理性骨折，減輕疼痛并促進(jìn)患者護(hù)理方面具有主要的姑息作用，試圖盡早為原發(fā)性腫瘤提供最合適的治療方法。

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