Metastatik Kemik Tümörlerinin Retrospektif Değerlendirmesi

Year 2022, Volume: 24 Issue: 3, 252 - 256, 30.12.2022

Nazlı Sena Seker Funda Canaz Ulukan İnan Mustafa Kavak Özge Bülbül

https://doi.org/10.18678/dtfd.1129573

Abstract

Amaç: Kemik dokusu sağlıklı bireylerde hematopoez ve osteogenezisin primer olarak yapıldığı organdır. Kemik dokusu en sık metastaz alan organlardan biridir. Ek olarak, tüm kanser türleri için kanserin artık iyileşemeyecek bir düzeye ulaştığının ve hastanın beklenen yaşam süresinin kısaldığının bir göstergesidir. Bu çalışmanın amacı, kemik metastazı nedeniyle ameliyat edilmiş olan olguların geriye dönük olarak değerlendirilmesidir.
Gereç ve Yöntemler: Ocak 2020 ve Ocak 2022 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesi'nde kemik tümörü nedeniyle biyopsi yapılan veya ameliyat edilen toplam 67 hasta bu çalışmaya dahil edilmiştir.
Bulgular: Metastatik olguların 49 (%73,1)'u erkek ve 18 (%26,9)'i kadın idi. Hastaların ortalama yaşı 61,7±19,8 (aralık, 9-88) yıl idi. En sık metastaz yapan tümörler erkeklerde akciğer karsinomu ve primeri bilinmeyen tümör iken, kadınlarda ise akciğer ve meme karsinomu olarak saptanmıştır. Tümörlerin en sık omurga bölgesine metastaz yaptığı tespit edilmiştir. Metastatik tümörlerin içinde primer odağın saptanamadığı 1'i (%1,5) mezenkimal olmak üzere toplam 6 (%9,0) olgu vardır.
Sonuç: Kemik ağrısı kanser tanısı ile takip edilen bir hastada her zaman metastaz açısından şüpheli olan ve ileri tetkik yapılması gereken bir semptomdur. Kemik metastazı sonrasında tedavi daha çok palyatif olmaktadır. Metastazı önlemeye yönelik hedefe yönelik çalışmalara ihtiyaç vardır. Ayrıca bir grup hastada tüm klinik ve görüntüleme yöntemlerine rağmen primer odağın tespit edilemeyebileceği de akılda tutulmalıdır.

Keywords

Kemik neoplazileri, tümör metastazı, bilinmeyen primer neoplazm metastaz

Retrospective Analysis of Metastatic Bone Tumors

Abstract

Aim: Bone tissue is the primary organ of hematopoiesis and osteogenesis in healthy individuals. Bone tissue is one of the most frequently metastasized organs. In addition, for all types of cancer, it is an indication that cancer has reached a level where it can no longer be cured and the patient's life expectancy is reduced. The aim of this study was to retrospectively evaluate the cases operated for bone metastasis.
Material and Methods: A total of 67 patients who underwent a biopsy or operation due to bone tumors at Eskişehir Osmangazi University Medical Faculty Hospital between January 2020 and January 2022 were included in this study.
Results: Of the metastatic cases, 49 (73.1%) were male and 18 (26.9%) were female. The mean age of the patients was 61.7±19.8 (range, 9-88) years. The most frequently metastasized tumors were lung carcinoma and tumor of unknown primary in males, while lung and breast in females. Tumors most frequently metastasize to the spine region. There were 6 (9.0%) cases, 1 (1.5%) of which was mesenchymal, in which the primary origin couldn’t be detected in metastatic tumors.
Conclusion: Bone pain is always a symptom that is suspicious for metastasis in a patient followed up with a diagnosis of cancer and requires further investigation. Treatment is more palliative after bone metastasis. There is a need for targeted studies to prevent metastasis. It should be kept in mind that the primary focus may not be detected in all clinical and imaging methods in a group of patients.

Keywords

Bone neoplasms, neoplasm metastases, unknown primary neoplasm metastases

References

• Reise SP, Waller NG. Item response theory and clinical measurement. Annu Rev Clin Psychol. 2009;5:27-48.
• Ban J, Fock V, Aryee DNT, Kovar H. Mechanisms, diagnosis and treatment of bone metastases. Cells. 2021;10(11):2944.
• Ren G, Esposito M, Kang Y. Bone metastasis and the metastatic niche. J Mol Med (Berl). 2015;93(11):1203-12.
• Zhang W, Bado I, Wang H, Lo HC, Zhang XH. Bone metastasis: find your niche and fit in. Trends Cancer. 2019;5(2):95-110.
• Shiozawa Y, Pienta KJ, Taichman RS. The hematopoietic stem cell niche is a potential therapeutic target for bone metastatic tumors. Clin Cancer Res. 2011;17(17):5553-8.
• Paget S. The distribution of secondary growths in cancer of the breast. Lancet. 1889;133(3421):571-3.
• Weilbaecher KN, Guise TA, McCauley LK. Cancer to bone: a fatal attraction. Nat Rev Cancer. 2011;11(6):411-25.
• Cecchini MG, Wetterwald A, van der Pluijm G, Thalmann GN. Molecular and biological mechanisms of bone metastasis. EAU Update Series. 2005;3(4):214-26.
• Coleman RE, Brown J, Holen I. Bone metastases. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. Abeloff's clinical oncology. 6th ed. Philadelphia, PA: Elsevier; 2020. p.809-30.e3.
• Shiozawa Y, Pedersen EA, Havens AM, Jung Y, Mishra A, Joseph J, et al. Human prostate cancer metastases target the hematopoietic stem cell niche to establish footholds in mouse bone marrow. J Clin Invest. 2011;121(4):1298-312.
• Sethakorn N, Heninger E, Sánchez-de-Diego C, Ding AB, Yada RC, Kerr SC, et al. Advancing treatment of bone metastases through novel translational approaches targeting the bone microenvironment. Cancers (Basel). 2022;14(3):757.
• Xiong Z, Deng G, Huang X, Li X, Xie X, Wang J, et al. Bone metastasis pattern in initial metastatic breast cancer: a population-based study. Cancer Manag Res. 2018;10:287-95.
• Mayadağlı A, Bulut G, Ekici K. Management of metastatic bone tumors. South Clin Ist Euras. 2011;22(1):49-55. Turkish.
• Brown JE, Cook RJ, Major P, Lipton A, Saad F, Smith M, et al. Bone turnover markers as predictors of skeletal complications in prostate cancer, lung cancer, and other solid tumors. J Natl Cancer Inst. 2005;97(1):59-69.
• Anract P, Biau D, Boudou-Rouquette P. Metastatic fractures of long limb bones. Orthop Traumatol Surg Res. 2017;103(1S): S41-S51.
• Sugiura H, Yamada K, Sugiura T, Hida T, Mitsudomi T. Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res. 2008;466(3):729-36.
• Ibrahim T, Flamini E, Mercatali L, Sacanna E, Serra P, Amadori D. Pathogenesis of osteoblastic bone metastases from prostate cancer. Cancer. 2010;116(6):1406-18.
• Suva LJ, Griffin RJ, Makhoul I. Mechanisms of bone metastases of breast cancer. Endocr Relat Cancer. 2009;16(3):703-13.
• Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001;27(3):165-76.
• Rose AA, Siegel PM. Emerging therapeutic targets in breast cancer bone metastasis. Future Oncol. 2010;6(1):55-74.
• Miller K, Clementi C, Polyak D, Eldar-Boock A, Benayoun L, Barshack I, et al. Poly(ethylene glycol)-paclitaxel-alendronate self-assembled micelles for the targeted treatment of breast cancer bone metastases. Biomaterials. 2013;34(15):3795-806.
• Tulotta C, Ottewell P. The role of IL-1B in breast cancer bone metastasis. Endocr Relat Cancer. 2018;25(7):R421-34.
• Hirsh V, Major PP, Lipton A, Cook RJ, Langer CJ, Smith MR, et al. Zoledronic acid and survival in patients with metastatic bone disease from lung cancer and elevated markers of osteoclast activity. J Thorac Oncol. 2008;3(3):228-36.
• Scagliotti GV, Hirsh V, Siena S, Henry DH, Woll PJ, Manegold C, et al. Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. J Thorac Oncol. 2012;7(12):1823-9.
• Kuchuk M, Addison CL, Clemons M, Kuchuk I, Wheatley-Price P. Incidence and consequences of bone metastases in lung cancer patients. J Bone Oncol. 2013;2(1):22-9.
• Çelik ZE, Harmankaya İ, Aydın BK, Yıldırım A. Retrospective analysis of 129 patients with metastatic bone tumors. Genel Tıp Derg. 2021;31(1):59-64. Turkish.
• Pavlidis N, Fizazi K. Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol. 2009;69(3):271-8.
• Pavlidis N, Pentheroudakis G. Cancer of the unknown primary site. Lancet. 2012;379(9824):1428-35.
• Kuchuk I, Hutton B, Moretto P, Ng T, Addison CL, Clemons M. Incidence, consequences and treatment of bone metastases in breast cancer patients-Experience from a single cancer centre. J Bone Oncol. 2013;2(4):137-44.
• Grünwald V, Eberhardt B, Bex A, Flörcken A, Gauler T, Derlin T, et al. An interdisciplinary consensus on the management of bone metastases from renal cell carcinoma. Nat Rev Urol. 2018;15(8):511-21.
• Steinmetz MP, Mekhail A, Benzel EC. Management of metastatic tumors of the spine: strategies and operative indications. Neurosurg Focus. 2001;11(6):e2.