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Skeletal Metastasis of Unknown Primary Origin at the Initial Visit: A Retrospective Analysis of 286 Cases.

Takagi T, Katagiri H, Kim Y, Suehara Y, Kubota D, Akaike K, Ishii M, Mukaihara K, Okubo T, Murata H, Takahashi M, Kaneko K, Saito T - PLoS ONE (2015)

Bottom Line: Lung cancer was identified in 72 (25.2%) cases, and was the most frequently observed primary lesion.The median survival times of prostate cancer cases was over 120 months, that of patients with primary lung cancers was 9.0 months and the median survival time of cases who were finally diagnosed with an unknown primary was 11.0 months.We believe that our study would contribute to establishing an optimal strategy for diagnosing the primary site in SMUP patients, and our data provide definite indications for the survival times for different SMUP situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.

ABSTRACT

Background: Skeletal metastasis is a common metastatic event for several carcinomas, and the treatment for skeletal metastasis of unknown primary (SMUP) are a critical issue in cancer therapy. Making a diagnosis of the primary site is the most crucial step in the treatment of SMUP; however, the procedures are sometimes difficult and time-consuming, and the primary site often remains unknown. Therefore, to establish optimal diagnostic strategies and elucidate the overall survival rates of SMUP, we conducted this retrospective study.

Methods: We retrospectively analyzed the clinical data for 286 SMUP cases from a total of 2,641 patients with skeletal metastases who were treated between 2002 and 2014 at our initiations.

Results: The primary sites were identified in 254/286 patients (88.8%), while 32 (11.2%) primary sites were not detected by our diagnostic strategies. Lung cancer was identified in 72 (25.2%) cases, and was the most frequently observed primary lesion. The median survival time of the SMUP patients was 20.0 months, while the median survival times of solitary bone metastasis cases and multi-bone metastasis cases were 39.0 months and 16.0 months, respectively. The median survival times of prostate cancer cases was over 120 months, that of patients with primary lung cancers was 9.0 months and the median survival time of cases who were finally diagnosed with an unknown primary was 11.0 months.

Conclusions: We believe that our study would contribute to establishing an optimal strategy for diagnosing the primary site in SMUP patients, and our data provide definite indications for the survival times for different SMUP situations.

No MeSH data available.


Related in: MedlinePlus

The diagnostic abilities of each step for identifying the primary tumors in 286 SMUP cases: The graph shows the diagnostic abilities of each examination step.We divided the steps into two categories: steps 1~5 as “common examinations”, and steps 6~9 as “advanced examinations”. Almost half of the SMUP cases (53.3%) were diagnosed by “common examinations”. Additionally, Step 9 (PET scan) was not efficient for identifying the primary site in our cohort. The details of these findings are shown in S2 Fig and Supplemental Table A in S1 File.
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pone.0129428.g003: The diagnostic abilities of each step for identifying the primary tumors in 286 SMUP cases: The graph shows the diagnostic abilities of each examination step.We divided the steps into two categories: steps 1~5 as “common examinations”, and steps 6~9 as “advanced examinations”. Almost half of the SMUP cases (53.3%) were diagnosed by “common examinations”. Additionally, Step 9 (PET scan) was not efficient for identifying the primary site in our cohort. The details of these findings are shown in S2 Fig and Supplemental Table A in S1 File.

Mentions: Next, we investigated the diagnostic abilities of each step (Fig 3, S2 Fig) for identifying the primary tumor. Step 1: only medical history-taking did not identify the primary site in any of the patients (0/286; 0%). In Step 2, physical examinations were also unable to identify the primary site in any of the patients (0/286, 0%). In Step 3, the chest X-rays identified the primary tumor in 17/286 (5.9%) cases. In Step 4, the blood tests identified the primary tumors in 49/286 (17.1%) cases, while in Step 5, the whole CT scans identified the primary tumors in 87/286 (30.4%) cases. In Step 6, the first of the advanced examinations, bone biopsies identified the primary tumor in 55/286 (19.2%) cases. In Step 7, origin examinations and origin biopsies identified the primary tumors in 41/286 (14.3%) cases. In the last two steps, the BMP in Step 8 identified the primary tumor in 2/286 (0.7%) cases, and the PET scans in Step 9 identified the primary tumors in 3/286 (1.0%) cases (Fig 3, S2 Fig). The details of the contents of these findings are shown in Supplemental Table A in S1 File.


Skeletal Metastasis of Unknown Primary Origin at the Initial Visit: A Retrospective Analysis of 286 Cases.

Takagi T, Katagiri H, Kim Y, Suehara Y, Kubota D, Akaike K, Ishii M, Mukaihara K, Okubo T, Murata H, Takahashi M, Kaneko K, Saito T - PLoS ONE (2015)

The diagnostic abilities of each step for identifying the primary tumors in 286 SMUP cases: The graph shows the diagnostic abilities of each examination step.We divided the steps into two categories: steps 1~5 as “common examinations”, and steps 6~9 as “advanced examinations”. Almost half of the SMUP cases (53.3%) were diagnosed by “common examinations”. Additionally, Step 9 (PET scan) was not efficient for identifying the primary site in our cohort. The details of these findings are shown in S2 Fig and Supplemental Table A in S1 File.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482691&req=5

pone.0129428.g003: The diagnostic abilities of each step for identifying the primary tumors in 286 SMUP cases: The graph shows the diagnostic abilities of each examination step.We divided the steps into two categories: steps 1~5 as “common examinations”, and steps 6~9 as “advanced examinations”. Almost half of the SMUP cases (53.3%) were diagnosed by “common examinations”. Additionally, Step 9 (PET scan) was not efficient for identifying the primary site in our cohort. The details of these findings are shown in S2 Fig and Supplemental Table A in S1 File.
Mentions: Next, we investigated the diagnostic abilities of each step (Fig 3, S2 Fig) for identifying the primary tumor. Step 1: only medical history-taking did not identify the primary site in any of the patients (0/286; 0%). In Step 2, physical examinations were also unable to identify the primary site in any of the patients (0/286, 0%). In Step 3, the chest X-rays identified the primary tumor in 17/286 (5.9%) cases. In Step 4, the blood tests identified the primary tumors in 49/286 (17.1%) cases, while in Step 5, the whole CT scans identified the primary tumors in 87/286 (30.4%) cases. In Step 6, the first of the advanced examinations, bone biopsies identified the primary tumor in 55/286 (19.2%) cases. In Step 7, origin examinations and origin biopsies identified the primary tumors in 41/286 (14.3%) cases. In the last two steps, the BMP in Step 8 identified the primary tumor in 2/286 (0.7%) cases, and the PET scans in Step 9 identified the primary tumors in 3/286 (1.0%) cases (Fig 3, S2 Fig). The details of the contents of these findings are shown in Supplemental Table A in S1 File.

Bottom Line: Lung cancer was identified in 72 (25.2%) cases, and was the most frequently observed primary lesion.The median survival times of prostate cancer cases was over 120 months, that of patients with primary lung cancers was 9.0 months and the median survival time of cases who were finally diagnosed with an unknown primary was 11.0 months.We believe that our study would contribute to establishing an optimal strategy for diagnosing the primary site in SMUP patients, and our data provide definite indications for the survival times for different SMUP situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.

ABSTRACT

Background: Skeletal metastasis is a common metastatic event for several carcinomas, and the treatment for skeletal metastasis of unknown primary (SMUP) are a critical issue in cancer therapy. Making a diagnosis of the primary site is the most crucial step in the treatment of SMUP; however, the procedures are sometimes difficult and time-consuming, and the primary site often remains unknown. Therefore, to establish optimal diagnostic strategies and elucidate the overall survival rates of SMUP, we conducted this retrospective study.

Methods: We retrospectively analyzed the clinical data for 286 SMUP cases from a total of 2,641 patients with skeletal metastases who were treated between 2002 and 2014 at our initiations.

Results: The primary sites were identified in 254/286 patients (88.8%), while 32 (11.2%) primary sites were not detected by our diagnostic strategies. Lung cancer was identified in 72 (25.2%) cases, and was the most frequently observed primary lesion. The median survival time of the SMUP patients was 20.0 months, while the median survival times of solitary bone metastasis cases and multi-bone metastasis cases were 39.0 months and 16.0 months, respectively. The median survival times of prostate cancer cases was over 120 months, that of patients with primary lung cancers was 9.0 months and the median survival time of cases who were finally diagnosed with an unknown primary was 11.0 months.

Conclusions: We believe that our study would contribute to establishing an optimal strategy for diagnosing the primary site in SMUP patients, and our data provide definite indications for the survival times for different SMUP situations.

No MeSH data available.


Related in: MedlinePlus