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.
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.
Lung is one of the most common metastatic organs of carcinomas. Pulmonary metastasectomy has become a common procedure in thoracic surgery and its effectiveness has been demonstrated by many researches. Once the malignant tumor is combined with lung metastasis, which belongs to the category of advanced tumor, surgical resection is only a palliative treatment to reduce the tumor load. However, there are still some controversies among the surgical indications, preoperative examinations, surgical methods and resection ranges, lymph node management, recurrence and re-resection of metastatic tumor and prognostic factors. This article reviews pulmonary metastasectomy from the above aspects.
Objective To analyze and summarize clinical characteristics, diagnostic method, choice of treatment, and prognosis of metastatic lung cancer to thyroid gland. Method The clinical materials of the 15 patients presenting with secondary thyroid cancer were analyzed retrospectively. Results There were 10 females and 5 males in the 15 patients, with the female to male ratio of 2 : 1. The age ranged from 36 to 79 years old with an average 59 years old. The diagnoses of 12 cases were made by the surgery or the fine needle aspiration biopsy (FNAB), 3 cases by the clinic. The interval from the diagnosis of the primary tumor to the thyroid metastasis varied from 0 month to 21 months with an average 4 months. Three patients received the thyroidectomy, 5 patients received the chemotherapy or chemoradiotherapy, and 7 patients gave up the treatment. The average survival time was 10 months. Conclusions Metastatic lung cancer to thyroid gland is rare, and FNAB is a useful tool for diagnosis. Thyroidectomy may not be recommended because of poor prognosis.
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 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 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.