Extrapulmonary Metastases Research Articles

Clinical outcomes of stereotactic ablative radiotherapy in patients with pulmonary metastasis.

In addition to its curative use for early stage lung cancer, stereotactic ablative radiotherapy is also indicated for pulmonary metastatic disease. Aims of this study were to retrospectively analyze treatment outcomes and to find prognostic factors for survivals. Treatment outcomes and toxicities of 85 cases of SABR in 72 patients were retrospectively reviewed from September 2012 to April 2015. Prognostic factors were analyzed using Cox proportional hazards regression. The local failure-free survival rate at 2 years was 98%. Of the case, 1-year and 2-year progression-free survival rates were 62% and 48%, and overall survival rates were 90% and 72%, respectively. Multivariate analyses demonstrated that controlled primary cancer (P=0.01), absence of extra-pulmonary metastatic disease (P<0.01) and disease-free interval longer than 1 year (P <0.01) favorably affected progression-free survival. Furthermore, the absence of extra-pulmonary metastatic disease (P<0.01) increased overall survival as well. Grade 1 or 2 radiation pneumonitis was found in 37 cases, and Grade 1 chest wall pain was found in 1 case. Stereotactic ablative radiotherapy demonstrated good local control with tolerable adverse effects for pulmonary metastasis. The presence or absence of extra-pulmonary metastasis was found to be prognostic factor of mortality after stereotactic ablative radiotherapy treatment.

Impact of disease free status on prognosis in metastatic non-small round cell soft tissue sarcomas.

The aim of this study is to examine the impact of disease free (DF) status on the prognosis in patients with metastatic non-small round cell soft tissue sarcoma (STS). We retrospectively reviewed 51 metastatic STS patients who were treated in Nagoya University Hospital from 2005 to 2015. The relation between various clinical factors and overall survival (OS) was analyzed. The log rank test and Cox's proportional hazards test were used to evaluate the differences between groups. p-values of <0.05 were considered to indicate significance. The median follow-up period after first metastasis was 23.5 (1.6-97.1) months. There were 30 males and 21 females with a median age of 62 (15-88) years at first metastasis. The histologic subtypes were 17 undifferentiated pleomorphic sarcoma, 10 liposarcoma, 8 malignant peripheral nerve sheath tumor, and 16 others. Thirty patients had more than 2 metastases, and 15 patients had primary or local recurrent tumors. The metastatic sites were 31 lung only, 8 bone only, and 12 others. Twenty-two patients achieved DF status after surgeries and in one case proton radiotherapy for bone metastasis. DF status was marginally or significantly associated with good prognosis in patients with both pulmonary (p=0.055) and extrapulmonary metastasis (p=0.029). On multivariate analysis, DF status (p=0.010) was an independent good prognostic factors for OS. In metastatic non-small round cell STS, it is an important treatment concept to achieve DF status whenever possible. This concept can apply both to pulmonary and extrapulmonary metastasis.

Single Center Prospective Phase II Trial of CT-guided Radiofrequency Ablation for Pulmonary Metastases from Colorectal Cancer (SCIRO-1401).

The present single center prospective phase II clinical trial is designed to evaluate the efficacy and safety of percutaneous radiofrequency (RF) ablation for colorectal lung metastases. Patients who have colorectal lung metastases without extrapulmonary metastases are included in this study. The primary endpoint is 3-year overall survival (OS) after RF ablation. The secondary endpoints are the prevalence of adverse events within 4 weeks, local tumor progression rate, 1- and 5-year OS, cause-specific survival, and relapse-free survival. The recruitment of patients commenced in July 2014, and the enrolment of 45 patients is intended over the 3 years of study period.

Évaluation de l’utilisation de la TEP au FDG pour le bilan des sarcomes de l’adulte en pratique quotidienne

FDG PET (PET)±computed tomography (CT) has increasingly been used in some areas of oncology imaging. It is sometimes performed outside recommendations, at diagnosis or monitoring of sarcomas. We assessed the value of PET-CT in routine practice in sarcomas. All consecutive sarcoma adult patient charts presented at the multidisciplinary sarcoma meeting in a tertiary care center over a period of 10months were examined in order to analyze the performances of PET-CT when available. Of 232patients, 50 (21%) underwent a PET-CT. Sensitivity and specificity of PET-CT were 94.7%, 57.1%, respectively. SUV values were highly variable, including for a given histology or grade. PET-CT resulted in practice changing in 14% of cases. When extrapulmonary metastases are suspected and for some subtypes of sarcomas, PET-CT could provide additional information because in view of its good sensitivity. Given the most frequent pulmonary tropism, first hand chest CT may be sufficient at first diagnostic work-up for the detection of pulmonary metastases. However, the relatively poor specificity suggests that further analyses should be performed to identify clinical situations where PET-CT may be of added value compared to current standards.

Oncological outcome after lung metastasis in patients presenting with localized chondrosarcoma at extremities: Tokai Musculoskeletal Oncology Consortium study.

The oncological outcome after lung metastasis in patients with chondrosarcoma of the extremities has not been reported. Between June 2000 and June 2013, 179 patients with chondrosarcoma in the extremities were treated at eleven hospitals. Twenty consecutive patients (11.2%) developed lung metastases after initial treatment of primary chondrosarcoma in the extremities. We investigated the oncological outcome of 20 chondrosarcoma patients with lung metastasis. There were 14 males and six females with a mean age of 49 years. The mean duration between primary surgery and appearance of lung metastases was 34 months. The mean follow-up period was 48 months. We excluded patients with lung metastasis at the time of presentation from this study. At the final follow-up, four of 20 patients had no evidence of disease, four were alive with disease, and twelve had died of disease. The 3- and 5-year survival rates after lung metastasis were 51.5% and 45.7%, respectively. Tumor grade, extrapulmonary metastasis, and treatment for lung metastases including metastasectomy and radiofrequency ablation were identified by univariate analysis to be significant prognostic factors for oncological analysis. In conclusion, this study evaluated the oncological outcome in patients with chondrosarcoma of the extremities with lung metastasis. Although a large-scale study might be required to confirm the results of this study, we suggest that metastasectomy and/or radiofrequency ablation should be considered to improve postmetastatic survival.

Anti‐invasive activity of capsaicin and non‐pungent capsaicin analogs in human SCLC

Small cell lung cancer (SCLC) is the most aggressive lung malignancy. A majority of SCLC patients show extrapulmonary metastasis at the time of their presentation. The common sites of SCLC metastasis are bone and the brain. The invasion of malignant cells to the neighboring blood vessels and lymph nodes is a key step of metastasis. Recent data indicate that dietary compounds (by themselves or in combination with standard chemotherapy) reduce invasion and metastasis of several human cancers. Capsaicin is the pungent ingredient of chili peppers. Recent studies have shown that capsaicin inhibits the invasion and metastasis of several types of human cancers including melanoma, prostate cancer and cholangiosarcoma. We tested the anti‐invasive activity of capsaicin, as well as two non‐pungent capsaicin analogs, olvanil and arvanil, in human SCLC using the Boyden chamber assay and spherical invasion assay. We found that olvanil and arvanil possess greater anti‐invasive activity than capsaicin. The biological activity of capsaicin is mediated by transient receptor potential vanilloid (TRPV) receptors on target cells. However, arvanil and olvanil bind to both TRPV and cannabinoid receptors. Boyden chamber and spherical invasion assay revealed that the anti‐invasive effects of capsaicin, olvanil and arvanil were independent of both TRPV and cannabinoid receptors. The capsaicin analogs olvanil and arvanil may prove useful for the management and treatment of SCLC metastasis.Support or Funding InformationFunding for our study was supported by the an NIH R15‐AREA Grant (1R15HL113681‐01A1), AICR Investigator Grant, and a NASA Undergraduate Fellowship to ATA.

Colorectal cancer with synchronous lung metastases: clinical characteristics, treatment, prognosis

Objective: to evaluate the impact of cytoreductive surgery on treatment results in patients with colorectal cancer and synchronous lung metastases. Materials and methods. This retrospective investigation analyzed the results of therapy in patients with colorectal cancer and synchronous lung metastases who had been treated in the period 2000 to 2012. The investigators studied the following indicators: the impact of cytoreductive surgery on the survival of patients with this condition, the clinical characteristics of a group of patients with isolated lung involvement, the dissimilarity of this group from a group of patients with extrapulmonary metastases, the possibility of performing complete cytoreductive surgery in patients with varying degrees of a metastatic process, and the number of patients with complications in primary tumor. Results. The investigations included the data of 112 patients with colorectal cancer and synchronous lung metastases. Out of them, 38 (33.9 %) patients had isolated lung involvement and the latter was associated with extrapulmonary metastases in 74 (64.1 %). In 16 of the 38 patients, isolated lung metastases were regarded as resectable and complete cytoreductive surgeries were performed. The median follow-up in the examined group was 15.2 months. One- and two-year overall survival rates were 63 and 45 %, respectively. The patients with isolated lung metastases were observed to have higher 2-year overall survival rates than those with multiple metastases (63.0 and 37.5 %, respectively; p = 0.055) and there were significantly higher 2-year overall survival rates in patients after removal of primary tumors than in those who had not undergone cytoreductive surgery (21.0 and 52.5 %, respectively; p = 0.004). Two-year overall survival rates were 72.5 % in the complete cytoreductive treatment group. Conclusion. The prognosis in the patients with colorectal cancer and synchronous lung metastases was better than that in those with isolated lung involvement and in those whose primary tumor had been removed. Complete cytoreductive surgical treatment can provide long-term survival in this category of patients.

Lower Limb Myxoid Liposarcoma with Distant Metastasis: Report of Two Cases and a Literature Review

Introduction: Liposarcoma, mainly involving the deep soft tissue of limbs and torso, especially lower limbs and retroperitoneum, is the second most common malignant tumour derived from primitive mesenchymal topped by malignant fibrous histiocytoma, accounting for 20% of soft tissue Liposarcoma is divided into five histologic subtypes and three biological types based on WHO classification criteria in 2002: 1) well-differentiated liposarcoma (WDLPS) and dedifferentiated liposarcoma (DDLPS); 2) myxoid liposarcoma (MLS) and round cell liposarcoma (RCLS); 3) pleomorphic liposarcoma (PLS). Among them, MLS is biologically characteristic; especially some patients with extrapulmonary metastases come out with poor prognosis. We hereby retrospectively analyse two MLS cases characterized as extrapulmonary metastases treated in our hospital from June 2007 to October 2015and reviewed related literatures as follows. Methods: We have retrospectively analysed two cases of MLS with distant extrapulmonary metastases and reviewed related literatures. Result: MLS is relatively sensitive to radiotherapy and chemotherapy, but the therapeutic outcome does not correlate with radiochemotherapy, the more the round cells and the malignant the myxoid liposarcoma. About 1/3 MLS patients have distant metastasis, with predilection to soft tissue and bone of other parts of body, while the bone scanning is usually negative. Conclusion: As one subtype of liposarcoma, MLS has many specific biological characteristics, like distant metastasis, and currently regular follow-up examination is needed for timely diagnosis and treatment, but individualized treatment may be the future research direction.

Relevant factors analysis on the survival of gastric cancer patients with lung metastasis

To investigate the factors affecting survival rate in gastric cancer patients with lung metastasis. Clinicopathological and follow-up data of 64 gastric cancer patients with lung metastasis treated at the Cancer Hospital of Tianjin Medical University from January 1995 to December 2011, were retrospectively analyzed. The survival rate was calculated. Univariate and multivariate analysis were performed to find the factors affecting survival rate using Log-rank test and Cox proportional hazards model, respectively. The median survival time was 7 months. The 1-, 2- and 3-year survival rates were 32.8%, 18.8% and 7.8% respectively. Univariate analysis showed that primary tumor location, type of lung metastasis, lung metastasis combined with other distant metastasis and chemotherapy were significant factors for prognosis (P<0.05). Multivariate analysis revealed that bilateral lung metastasis(HR=2.093, 95% CI: 1.092-4.014, P=0.026) and lung metastasis combined with other distant metastasis (HR=2.433, 95% CI: 1.359-4.358, P=0.003) were independent risk prognostic factors, while chemotherapy was independent protective factor(HR=0.387, 95% CI: 0.211-0.710, P=0.002). Prognosis of gastric cancer patients with lung metastasis is quite poor, especially those with bilateral lung involvement and extra-pulmonary metastasis. Systemic chemotherapy may improve the prognosis of these patients.

Computed Tomography Features of Septic Pulmonary Embolism Caused by Klebsiella pneumoniae Liver Abscess Associated With Extrapulmonary Metastatic Infection.

The aims of the study were to investigate the computed tomography (CT) features and clinical course of septic pulmonary embolism (SPE) caused by Klebsiella pneumoniae liver abscess (KPLA) and to explore the possible mechanism underlying the spread of infection. Twenty-one patients with KPLA-induced SPE admitted to our hospital between January 2010 and May 2015 were evaluated. According to the presence or absence of extrapulmonary metastatic infection (EMI), they were divided into EMI and non-EMI groups and clinical and CT features of the 2 groups were compared. Hepatic vein thrombophlebitis was evaluated on liver CT images. Chest CT features included nodules, wedge-shaped lesions, ground-glass opacity, consolidation, cavitation, feeding vessel sign, pleural effusion, and lymphadenopathy. All the vessels within the so-called feeding vessel sign were confirmed as pulmonary veins by multiplanar reconstruction, so we used an alternative name draining vessel sign (DVS) instead. Peripheral nodules, DVS, and consolidation were the main CT features of KPLA-induced SPE. Peripheral nodules and DVS were more frequently seen in the EMI group than in the non-EMI group (P = 0.019 and 0.008, respectively). Five of 8 patients with hepatic vein thrombophlebitis had lung consolidation, whereas only 3 of 13 patients without hepatic vein thrombophlebitis had lung consolidation, although the difference was not significant (P = 0.09). Multiple pulmonary nodules and DVS were associated with EMI. Hepatic and pulmonary vein invasion are possible causes underlying the metastatic spread of infection.

Pulmonary Resection for Metastatic Gastric Cancer.

Pulmonary metastasectomy has come to be recognized as an effective treatment for selected patients with some malignancies. On the other hand, the role of pulmonary metastasectomy for gastric cancer is still unknown. Metastasectomy is rarely indicated in cases of pulmonary metastasis from gastric cancer, because in most cases, the metastasis occurs in the form of lymphangitic carcinomatosis and the lesions are numerous. The purpose of this study was to determine the surgical outcomes and prognostic factors for survival after pulmonary metastasectomy. From 1985 to 2012, 10 patients underwent pulmonary metastasectomy for gastric cancer at Saitama Cancer Center, Japan. The overall survival rate was examined by the Kaplan-Meier method and univariate analysis was carried out to identify prognostic factors. The overall 3-year survival rate was 30.0 %. The median follow-up period was 26.8 months (range, 6.5-96.6) after the pulmonary metastasectomy. Univariate analysis revealed an advanced pathological stage of the gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy as unfavorable prognostic factors. Pulmonary metastasectomy should be considered in selected patients with lung metastasis from gastric cancer. An advanced pathological stage of gastric cancer and occurrence of extrapulmonary metastasis before the pulmonary metastasectomy are unfavorable prognostic factors.

Impact of preoperative 18F-FDG PET/CT on survival of resected mono-metastatic non-small cell lung cancer

ObjectivesSurgery has been available for the treatment of mono-metastatic, non-small cell lung cancer (NSCLC) and promising overall survival was observed in some retrospective studies with selected patients. This study investigated whether the preoperative 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scan influences survival in this patient group. Furthermore we tried to identify other prognostic factors associated with survival and aimed to clarify if synchronous metastases are different from metachronous disease. MethodsBetween 1994 and 2012, 181 patients underwent resection for solitary metastases. Sixty-six patients underwent surgery after an initial FDG-PET/CT scan, whereas 115 patients underwent conventional preoperative staging by a spiral CT scan. ResultsThe overall 5-year survival rate was 38.8%. The 5-year survival rates after preoperative evaluation by FDG-PET/CT and by conventional CT were 58% and 33%, respectively (p=0.01). A higher 5-year survival rate was observed in patients without thoracic lymph node involvement (pN0: 44% vs. pN1-3: 33%, p=0.028). In patients with a solitary pulmonary metastasis, we observed a 5-year survival rate of 45.7%, whereas in patients with extrapulmonary metastases, the 5-year survival rate was 27.1% (p=0.001). In patients with a locally limited primary lung cancer according to the pT descriptor, we observed a 5-year survival rate of 53.1%, whereas in patients with a pT>1 descriptor, the 5-year survival rate was 33.6% (p=0.016). By multivariate analyses, we showed that preoperative FDG-PET/CT evaluation, no thoracic lymph node metastases, and sole pulmonary metastatic disease were favorable predictors of survival, whereas the time of metastasis (synchronous vs. metachronous) and maximum standardized uptake value was not. ConclusionsWe conclude that resection of the primary tumor and metastasectomy for mono-metastatic NSCLC can be performed after a comprehensive evaluation with FDG-PET/CT. N-stage and the site of the oligometastases have a significant influence on overall survival.

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors.

We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.

Molecular Testing Is a Valuable Adjunct for Distinguishing Second Primary Tumors of Lung From Intrapulmonary and Extrapulmonary Metastases

Background: Multiple lung tumor nodules may be the result of synchronous second primary tumors (SPTs) or metastasis. Patients with SPTs have better survival and may require different therapy than those with metastatic disease. The distinction between these entities is typically made on histology alone. However, the distinction is not always clear as SPTs may have similar histological appearances and …

Synchronous Triple Primary Lung Cancer: A Rare Case with Radiologic-Pathologic Correlation

According to the diagnostic criteria of Martini and Melamed (1), synchronous multiple primary lung cancers are physically distinct, separate, and originate from different carcinomas insitu or show different histologic types without involvement of common lymphatics or extrapulmonary metastases. Multiple synchronous primary lung cancer is rare with a low and variable incidence rate of 1–16% (2). Furthermore, the reported incidence of synchronous triple lung cancers is approximately 0.02% (3). We reported the case of a patient with synchronous triple and histologically different primary lung cancers. Furthermore, we determined the correlation of the radiologic features with pathology.

Indeterminate pulmonary nodules in colorectal cancer.

To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer (CRC) patients after lung operation of indeterminate pulmonary nodules (IPNs). From a prospective database of CRC patients, 40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography (CT) were enrolled. The decision to perform a lung operation was made if the patient met the following criteria: (1) completely resected or resectable primary CRC; (2) completely resectable IPNs; (3) controlled or controllable extrapulmonary metastasis; and (4) adequate general condition and pulmonary function to tolerate pulmonary operation. Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation. A total of 40 cases of lung resection was performed in 29 patients. Five patients underwent repeated lung resection. The final pathology result showed metastasis from the CRC in 30 cases (75%) and benign pathology in 10 cases (25%). The primary tumor site was the rectum in 26/30 (86.6%) cases with pulmonary metastasis, but only 3/10 (30%) cases in the benign group had a primary rectal cancer (P = 0.001). Positron emission tomography (PET)-CT was performed for 22/30 (73.4%) patients in the lung metastasis group and for 6/10 (60.0%) patients in the benign group. PET-CT revealed hot uptake of (18)fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups. The group with pulmonary metastasis had a higher incidence of primary rectal cancer (P = 0.001), a more advanced tumor stage (P = 0.011), and more frequent lymphatic invasion of tumor cells (P = 0.005). Six cases with previous liver metastasectomy were present in the lung metastasis group. Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients. The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.

Whole-Lung Irradiation for Adults With Pulmonary Metastases From Ewing Sarcoma

Whole-Lung Irradiation for Adults With Pulmonary Metastases From Ewing Sarcoma

Whole Lung Irradiation for Adults With Pulmonary Metastases From Ewing Sarcoma

To evaluate feasibility and patterns of failure in adult patients with Ewing sarcoma (ES) treated with whole lung irradiation (WLI) for pulmonary metastases. Retrospective review of all ES patients treated at age 18 or older with 12-15 Gy WLI for pulmonary metastases at a single institution between 1990 and 2014. Twenty-six patients met the study criteria. The median age at WLI was 23 years (range, 18-40). The median follow-up time of the surviving patients was 3.8 years (range, 1.0-9.6). The 3-year cumulative incidence of pulmonary relapse (PR) was 55%, with a 3-year cumulative incidence of PR as the site of first relapse of 42%. The 3-year event-free survival (EFS) and overall survival (OS) were 38 and 45%, respectively. Patients with exclusively pulmonary metastases had better outcomes than did those with extrapulmonary metastases: the 3-year PR was 45% in those with exclusively lung metastases versus 76% in those with extrapulmonary metastases (P=.01); the 3-year EFS was 49% versus 14% (P=.003); and the 3-year OS was 61% versus 13% (P=.009). Smoking status was a significant prognostic factor for EFS: the 3-year EFS was 61% in nonsmokers versus 11% in smokers (P=.04). Two patients experienced herpes zoster in the radiation field 6 and 12 weeks after radiation. No patients experienced pneumonitis or cardiac toxicity, and no significant acute or late sequelae were observed among the survivors. WLI in adult patients with ES and lung metastases is well tolerated and is associated with freedom from PR of 45% at 3 years. Given its acceptable toxicity and potential therapeutic effect, WLI for pulmonary metastases in ES should be considered for adults, as it is in pediatric patients. All patients should be advised to quit smoking before receiving WLI.

Osteosarcoma with metastasis at initial diagnosis: Current outcomes and prognostic factors in the context of a comprehensive cancer center.

The aim of this study was to report the outcomes and prognostic factors for a cohort of patients with osteosarcoma who presented with metastasis at initial diagnosis. Data of consecutive patients with osteosarcoma and metastatic disease at initial presentation, who were treated and followed up at a single institution, were retrospectively reviewed. The effect of potential factors on overall survival (OS) was analyzed through univariate and multivariate analysis. Between January, 2000 and March, 2013, a total of 135 patients with osteosarcoma, of whom 21 (16.0%) had distant metastasis at initial presentation, were diagnosed and treated at our center and were included in this analysis. The patients were treated with a strategy that integrates multi-agent chemotherapy and resection of all sites of gross disease whenever feasible. The 5-year OS and event-free survival (EFS) were 23.0% and 11.0%, respectively. The factors associated with inferior OS in the univariate analysis included the osteoblastic variant, extrapulmonary metastasis and failure to achieve complete remission. In the multivariate analysis, the osteoblastic variant [hazard ratio (HR)=4.83, 95% confidence interval (CI): 1.16-20.0, P=0.038] and extrapulmonary metastasis (HR=5.0, 95% CI: 1.40-17.94, P=0.018) were the only independent prognostic factors. The current outcomes of patients with osteosarcoma and metastasis at initial diagnosis remained poor. The osteoblastic subtype and extrapulmonary metastatic sites predicted poor survival in our series. To the best of our knowledge, this is the first report of the correlation between the histological subtype and survival for patients with metastatic disease at initial presentation; therefore, confirmation in future studies is required.

Incidence of inconsistent driver mutations between multiple lung ground-glass nodules in patients with non-small cell lung cancer.

11068 Background: Intertumor heterogeneity had been observed in various kinds of malignant tumors including non-small cell lung cancer. Comparing with extra-pulmonary metastasis, patients with mult...