Primary Lung Cancer Metastasis Research Articles

Application of random survival forest to establish a nomogram combining clinlabomics-score and clinical data for predicting brain metastasis in primary lung cancer.

To establish a nomogram for predicting brain metastasis (BM) in primary lung cancer at 12, 18, and 24months after initial diagnosis. In this study, we included 428 patients who were diagnosed with primary lung cancer at Harbin Medical University Cancer Hospital between January 2020 and January 2022. The endpoint event was BM. The patients were randomly categorized into two groups in a 7:3 ratio: training (n = 299) and validation (n = 129) sets. Least absolute shrinkage and selection operator was utilized to analyze the laboratory test results in the training set. Furthermore, clinlabomics-score was determined using regression coefficients. Then, clinlabomics-score was combined with clinical data to construct a nomogram using random survival forest (RSF) and Cox multivariate regression. Then, various methods were used to evaluate the performance of the nomogram. Five independent predictive factors (pathological type, diameter, lymph node metastasis, non-lymph node metastasis and clinlabomics-score) were used to construct the nomogram. In the validation set, the bootstrap C-index was 0.7672 (95% CI 0.7092-0.8037), 12-month AUC was 0.787 (95% CI 0.708-0.865), 18-month AUC was 0.809 (95% CI 0.735-0.884), and 24-month AUC was 0.858 (95% CI 0.792-0.924). In addition, the calibration curve, decision curve analysis and Kaplan-Meier curves revealed a good performance of the nomogram. Finally, we constructed and validated a nomogram to predict BM risk in primary lung cancer. Our nomogram can identify patients at high risk of BM and provide a reference for clinical decision-making at different disease time points.

Gastric Metastasis from Primary Lung Adenocarcinoma: A Case Report

<p>原發性肺癌是臨床上常見的癌症，目前研究對於肺癌的診斷、臨床及病理表現、治療等等日新月異。然而，原發性肺癌合併腸胃道轉移的個案則是相當罕見，因為其常以無症狀或非特異性症狀表現，在臨床上容易被忽略或誤診。原發性肺癌合併胃部轉移與原發性胃癌在組織學的表現十分相似，需要依靠免疫組織化學染色（包含腫瘤細胞角蛋白7 (CK7)、甲狀腺轉錄因子-1 (TTF-1)、腫瘤細胞角蛋白20 (CK20)）協助鑑別診斷。此篇病例報告呈現一位原發性肺癌合併胃部轉移的個案，臨床表現包含長久的消化不良以及體重減輕，在追蹤期間被診斷為化療造成的不適，最後經免疫組織化學染色確診為原發性肺癌合併胃部轉移。</p> <p> </p><p>Primary lung cancer is very common and fatal. However, cases of primary lung cancer with gastrointestinal metastases are relatively rare. We present a case of gastric metastasis from primary lung adenocarcinoma with clinical manifestations including dyspepsia and weight loss. The patient was initially thought to undergo chemotherapy-induced side effects but later diagnosed as gastric metastasis from primary lung cancer (GMLC) through special immunohistochemical staining of tissue for thyroid transcription factor-1 (TTF-1) and cytokeratin-7 (CK-7). Since the gastrointestinal (GI) tract remains a rare site of metastasis of primary lung cancer, GMLC is primarily described in case series. The incidence is considered underestimated, and the main reason is that it mostly presents with asymptomatic and nonspecific symptoms which sometimes may be regarded as the side effects of chemotherapy, hence misidentified as primary gastric cancer. Complications such as acute gastric bleeding and gastric perforation occur in patients with gastric metastasis and may result in death in severe cases. The presentation of gastric metastasis is difficult to differentiate from primary gastric cancer under endoscopy, leading to misdiagnosis and inadequate treatment. As the histological appearance of primary lung cancer with gastric metastasis is highly similar to that of primary gastric cancer, immunohistochemistry (IHC) staining is needed to assist in differential diagnosis.</p> <p> </p>

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

BackgroundGastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.MethodsWe conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.ResultsSeventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.ConclusionsClinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.

The Pilot Study of Spectral CT for the Diagnosis of Mediastinal Lymph Node Metastasis in Primary Lung Cancer

Objective: To investigate the application value of spectral CT for the diagnosis of mediastinal lymph node metastasis in primary lung cancer. Materials and Methods: 32 patients who had primary lung cancer with 90 enlarged mediastinal lymph nodes underwent spectral CT by using gemstone spectral imaging (GSI) mode. The spectral curves of regions of interest (ROI) in primary lung cancer and mediastinal lymph nodes were measured with GSI post-processing software. The spectral curve slope between 40 and 140 keV was calculated and compared between them for the diagnosis of mediastinal lymph node metastasis. The data were divided into metastatic group (group A) and non-metastatic group (group B) according to the pathologic findings. SPSS17.0 software with paired sample t test was used for statistical analysis and P < 0.05 was considered statistically significant difference. Results: The spectral curve slopes in primary lung cancer and mediastinal lymph node in group B were 0.96 ± 0.13 and 1.32 ± 0.17. There was significant difference between them (t = –2.68, P < 0.05). While there was no significant difference between them in group A (t = –1.62, P > 0.05) with the values of 1.06 ± 0.09 and 1.09 ± 0.12. The accuracy, sensitivity and specificity of diagnosing mediastinal lymph node metastasis were 84.21%, 86.67% and 82.77%, respectively in line with spectral curve. Conclusions: Spectral CT, as a new and non-invasive method, has valuable effect for the diagnosis of mediastinal lymph node metastasis in pre-operative staging of lung cancer.

"Squamos cell lung cancer" case applying with dyspepsia complaints

Abstract We present a patient with uncommon metastases of lung cancer. The patient has been followed-up for early stage laryngeal carcinoma in the remission and has had dyspeptic complaints as well. A 62-year-old male patient had epigastric complaints for three months. In the upper endoscopy, a biopsy specimen taken from the polyp in the second region of the duodenum was reported as squamous cell cancer. Immunohistochemical staining of tumor cells were positive for CK5/6, p40, and p63. A mass in the right lung was detected on thorax tomography. The result of the transthoracic needle biopsy indicated squamous cell cancer. Duodenal metastasis of lung cancer is highly unlikely. Lesions below 1 cm can be safely removed endoscopically. Duodenal metastasis of primary lung cancer can be considered in the differential diagnosis of resistant dyspepsia.

Gastrointestinal metastasis of primary lung cancer: An analysis of 366 cases.

The gastrointestinal (GI) tract is not a common site of metastasis in primary lung cancer. The aim of the present study was to reveal the clinical and prognostic characteristics of gastrointestinal metastases of lung cancer (GMLC). Information on 366 cases of GMLC was collected and factors that affect severe GI complications were analyzed. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model. Of the cases analyzed, the small intestine (59.6%) and colorectum (25.6%) were the two organs where lung cancer was most likely to metastasize in the GI tract. Squamous cell carcinoma (28.5%), adenocarcinoma (27.6%) and large cell carcinoma (20.9%) were the three most common histological types. However, compared with the histological distributions of primary lung cancer, patients with large cell carcinoma exhibited the highest elevated risk of GMLC [relative risk (RR), 4.07; P<0.001] and those with adenocarcinoma exhibited the lowest risk (RR, 0.58; P<0.001). Differences in organ involvement and in histological type led to varying GI complications. It was also indicated that chemotherapy was associated with a decreased risk of hemorrhage (P=0.006), but there was no reduction in the risk of hemorrhage associated with perforation and obstruction (P>0.05). The median overall survival time of GMLC patients was 2.8 months (range, 0–108 months). The survival analyses revealed that perforation and extra-GI metastasis were negative prognostic factors but abdominal surgery was identified a positive prognostic factor. In conclusion, the histological distribution of GMLC differed from that of primary lung cancer. Sufficient and careful patient evaluation, targeted surgeries and systemic therapies for specific patients are able to increase patient survival rate and improve the quality of life.

Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis.

The prevalence of gastrointestinal metastasis of lung cancer is low. The aim of the present study was to analyze the frequency and clinical characteristics of metastases to the gastrointestinal tract by retrospectively assessing the clinical records of 2,066 patients with lung cancer. A total of 7 patients (0.33%) were diagnosed with gastrointestinal metastasis, including 4 patients with adenocarcinoma, 1 patient with large cell carcinoma and 2 patients with pleomorphic carcinoma. Furthermore, 3 of the patients presented with small bowel metastases, 2 with gastric metastases, 1 with large bowel metastasis and 1 with metastasis of the appendix. The mean time between the diagnosis of the lung tumors and the identification of gastrointestinal metastasis was 13.5 months (range, 3-49 months). The mean time between the identification of the gastrointestinal metastasis and mortality was 100.6 days (range, 21-145 days). In conclusion, the prognosis of patients with recurrence in distant organs, including the gastrointestinal tract, may be worse than patients with recurrence in distant organs, excluding the gastrointestinal tract, particularly those with symptomatic gastrointestinal metastasis. Therefore, the presence of clinical gastrointestinal metastasis may be life threatening; comprehensive evaluations are required to detect and monitor gastrointestinal metastasis during follow-up.

Circulating tumor cell (CTC) as a significant prognostic factor in resected primary lung cancer.

e23044 Background: Circulating tumor cell (CTC) is a potentially useful marker in early diagnosis and monitoring therapeutic effects for patients with malignant tumors, but clinical significance of CTC in primary lung cancer remains unclear. We previously showed that CTC was a useful surrogate marker of distant metastasis in primary lung cancer (Clin Cancer Res 2009). In this study, we evaluated the prognostic value among completely resected patients after long-term follow-up. Methods: A total of 94 patients (median age, 68 years; 30 females and 64 males) who underwent complete resection for primary lung cancer (4 with small cell and 90 with non-small cell) were prospectively evaluated. At the time of enrollment into the study, 7.5mL of peripheral blood was sampled from each patient, and an EpCAM-based detection system (CellSearch) was used for detection of CTC. CTC was detected in 16 patients (CTC-positive, 14.9%). Results: CTC-positivity was significantly associated with a poor recurrence-free survival (5-year recurrence-free survival rate, 40% versus 72%; p&lt;0.01) (Table 1), which was confirmed by a multivariate analysis (hazard ratio, 2.57 [95% CI, 1.26-5.26]; P=0.010). CTC-positivity was also associated with a poor overall survival (5-year recurrence-free survival rate, 62% versus 84%; p&lt;0.05) (Table 1), which was confirmed by a multivariate analysis (hazard ratio, 2.76 [95% CI, 1.14-6.71]; P=0.025). Conclusions: CTC-positivity was associated with poor recurrence-free survival and poor overall survival in resected lung cancer. [Table: see text]

Clinical value of ultrasound in the diagnosis of supraclavicular lymph node metastasis of primary lung cancer

背景与目的原发性肺癌是常见的恶性肿瘤之一，术前准确的局部淋巴结（N）分期可避免不必要的手术创伤，N3期已非手术治疗指征。本研究旨在探讨超声在诊断原发性肺癌锁骨上淋巴结转移及确定其分期中的应用价值。方法回顾性分析2012年10月-2013年11月经病理确诊为肺癌患者131例，所有患者均在术前行锁骨上区域的超声和增强计算机断层扫描（computed tomography, CT），对检查结果为阳性的患者行超声引导下穿刺活检，将组织病理学诊断作为淋巴结转移的诊断标准，对比两种检查方法与病理结果的一致性。结果131例肺癌患者中经病理证实共有50例为锁骨上淋巴结转移，经超声检查阳性者54例，转移者50例；增强CT检查阳性者41例，其中36例为恶性。超声的灵敏度、特异度、正确指数、阳性预测值及阴性预测值（分别为100%、95.06%、95.06%、92.59%、100%）明显高于增强CT（分别为72%、93.83%、65.83%、87.80%、84.44%）。两种方法在确定肺癌TNM分期准确性的差异存在统计学意义（P < 0.01）。结论与增强CT相比，超声在原发性肺癌锁骨上淋巴结转移方面具有较高的准确性、敏感性和特异性，并且能够更加准确地确定原发性肺癌的TNM分期。

Pleuropneumonectomy for diffuse pleural metastasis in primary lung cancer

The purpose of this study is to analyze a single institution experience with pleuropneumonectomy for pleural metastasis and malignant pleural effusion in primary lung cancer. From August 1978 to August 2011, 66 consecutive patients with lung cancer underwent pleuropneumonectomy. Patients were followed-up after the operation. The quality-of-life and the survival time were recorded. All the 66 patients were successfully operated on, including 38 patients in early years (1978-1993) and 28 patients in recent years (1994-2011). Two patients in early years died after the operation. Post-operative complications occurred including heart arrhythmia, respiratory insufficiency and bacterial infection of residual lung, chylothoraxin and mental disorder. A total of 61 patients have been successfully followed-up and three patients in early years were lost in 1 year after the operation. Local recurrence was found in seven cases (4 in early years, 3 in recent years) and distant metastasis was found in 48 cases (29 in early years, 19 in recent years). A total of 54 patients died from tumors, seven patients survived. The actuarial 1, 2 and 3-year survival rates are 72.7%, 27.2% and 6.1% of 36 in patients of early years and 85.7%, 46.4% and 21.4% in 28 patients of recent years. The mean survival and the median survival of the total 64 patients were 20.0 ± 10.9 months and 17 months respectively. Further analysis showed that the mean survival and the median survival of the 36 patients in early years were 17.2 ± 9.7 months and 15 months, in contrast to 23.4 ± 11.3 months and 18 months of the 28 patients in recent years. Pleuropneumonectomy is an option of patients with advanced-stage lung cancer associated with uncontrolled malignant pleural fluid by conservative therapies. Strict selection of patient to be operated, careful procedures to eradicate obvious tumors and metastasis and enhanced post-operative combined therapy are beneficial to patients' long-term survival.

Metastatic lung adenocarcinoma mimicking a colonic polyp

Metastatic lung adenocarcinoma mimicking a colonic polyp

Combined Robotic Lobectomy and Adrenalectomy for Lung Cancer and Solitary Adrenal Metastasis

Surgical resection of isolated adrenal metastasis in primary lung cancer is associated with improved survival. We report a combined robotic lobectomy and adrenalectomy for resection of a primary lung cancer and metastasis to the adrenal gland. A 69-year-old male with a significant smoking history and shortness of breath was found to have a 3-cm left upper lobe mass with an enlarged left adrenal gland measuring 1.5cm. The adrenal gland was biopsied confirming metastatic poorly differentiated carcinoma, likely lung cancer. Computed tomography, positron emission tomography, and mediastinoscopy revealed no evidence of disease outside the adrenal gland. Following induction chemotherapy, the patient underwent combination robotic lobectomy, lymphadenectomy, and adrenalectomy while in the same lateral decubitus position. Thoracic and urologic oncology teams performed their respective portions of the operation. Overall operative time was 4 hours, and length of hospital stay was 3 days. Estimated blood loss was 150mL with no narcotic requirements beyond the first postoperative day. Final pathology revealed large cell carcinoma of the lung with metastasis to the adrenal. All surgical margins were negative. Combination robotic lobectomy and adrenalectomy is feasible and can be associated with a short convalescence, minimal pain, and an oncologically sound approach.

UP-02.060 Combined Robotic Lobectomy and Adrenalectomy for Lung Cancer and Solitary Adrenal Metastasis

Surgical resection of isolated adrenal metastasis in primary lung cancer is associated with improved survival. We report on same-setting combined robotic lobectomy and adrenalectomy for resection of a lung mass and metastasis to the adrenal.

(99m)Tc-MDP wholebody bone imaging in evaluation of the characteristics of bone metastasis of primary lung cancer

To explore the image characteristics of bone metastasis of primary lung carcinoma. Whole-body bone imaging ((99)Tc(m)-MDP) was performed in 258 patients with pathologically proven lung carcinoma. The rate of bone metastasis, distribution of the metastatic lesions and their characteristics were analyzed. Among the 258 cases, 142 patients developed bone metastasis. The overall rate of bone metastasis was 55.0%. The metastases located in axial skeleton were 49.6%, appendicular skeleton 36.0%, trunk bones of the axial skeleton 48.4%, and appendicular girdle skeleton 31.4%. Ribs, thoracic vertebrae, ilium and lumbar vertebrae had a higher rate of bone metastasis, higher than 20%, respectively. 1252 lesions were detected including 406 at the left side of the body, 387 in the axial skeleton and 459 at the right side of the body. There was no significant difference in terms of number of lesions between left side and right side (chi(2) = 3.3, P = 0.072). 1224 bone metastatic foci (97.8%) were presented as strong radioactive, 26 (2.1%) mixed lesion, and 2 (0.2%) low radioactive. According to the shape of the lesions, there were 810 punctate lesions (71.5%), 159 (14.0%) lump form, 108 (9.5%) strip form and 56 (4.9%) lamellar form. The accumulative bone metastasis rate was 28.7% for the patients with one to three lesions. The metastasis rate decreased gradually with the increasing number of metastatic lesions. Bone metastasis is very common in patients with lung cancer. Most bone metastases are characterized by strong radioactive and earlier punctate form, often occurs in the trunk bones of axial skeleton or appendicular girdles. The distribution of earlier metastases has not obvious regularity, and advanced bone metastases are often concurrent, multiple and multiform, widely and randomly distributed in the body.

Circulating Tumor Cell as a Diagnostic Marker in Primary Lung Cancer

To investigate the diagnostic performance of circulating tumor cells (CTC) in discrimination between primary lung cancer and nonmalignant diseases as well as in prediction of distant metastasis. We prospectively evaluated CTCs in 7.5-mL samples of peripheral blood sampled from patients with a suspicion or a diagnosis of primary lung cancer. A semiautomated system was used to capture CTCs with an antibody against epithelial cell adhesion molecule. Of 150 eligible patients, 25 were finally diagnosed as having nonmalignant disease, and 125 were diagnosed as having primary lung cancer with (n = 31) or without (n = 94) distant metastasis. CTCs were detected in 30.6% of lung cancer patients and in 12.0% of nonmalignant patients. CTC count was significantly higher in lung cancer patients than in nonmalignant patients, but a receiver operating characteristic (ROC) curve analysis showed an insufficient capability of the CTC test in discrimination between lung cancer and nonmalignant diseases with an area under ROC curve of 0.598 (95% confidence interval, 0.488-0.708; P = 0.122). Among lung cancer patients, CTC count significantly increased along with tumor progression, especially with development of distant metastasis. The area under ROC curve for CTC count in prediction of distant metastasis was 0.783 (95% confidence interval, 0.679-0.886; P < 0.001). When patients with one or more CTCs were judged as having metastatic disease, sensitivity and specificity of the CTC test were 71.0% and 83.0%, respectively. CTC is a useful surrogate marker of distant metastasis in primary lung cancer.

Tracheal metastasis of small cell lung cancer

Endotracheal metastases of primary lung cancer are rare. Only one case of tracheal metastasis from small cell lung cancer has been reported in literature. Here, we report a rare case of a 45-year-old woman who was admitted for sudden-onset breathlessness with respiratory failure and required ventilatory support. Endotracheal growth was identified during bronchoscopy, and biopsy revealed endotracheal metastasis of small cell lung cancer.

Functional Polymorphisms ofMatrix Metalloproteinase-9Are Associated with Risk of Occurrence and Metastasis of Lung Cancer

Matrix metalloproteinase 9 (MMP-9) plays critical roles in cancer development and aggression. Nonsynonymous single-nucleotide polymorphisms (SNP) in the functional domain of the MMP-9 gene may influence substrate and inhibitor binding and contribute to cancer predisposition and aggression. To test our hypothesis that common nonsynonymous SNPs, R279Q, P574R, and R668Q, in MMP-9 are associated with lung cancer development and metastasis, we conducted a case-control study of 744 patients with incident lung cancer and 747 cancer-free controls in Southeast China. Multivariate logistic regression analysis was used to calculate adjusted odds ratio (OR) and 95% confidence interval (95% CI). We found that compared with the 279QQ genotype, the 279RR genotype was associated with significant elevated risk of lung cancer with metastasis (adjusted OR, 1.79; 95% CI, 1.03-3.08), whereas the 574PR heterozygote and 574PP homozygote had 1.46-fold (95% CI, 0.94-2.26) and 1.69-fold elevated risk (95% CI, 1.10-2.60), respectively, compared with the 574RR genotype. When we examined the combined effect of R279Q and P574R and used the 279R and 574P as the risk alleles, a significantly increased risk of lung cancer was associated with both the genotypes containing "1 to 2 risk alleles" (adjusted OR, 2.16; 95% CI, 1.30-3.59) and containing ">2 risk alleles" (adjusted OR, 2.44; 95% CI, 1.48-4.03), and it was more pronounced in 290 lung cancer cases with metastasis [adjusted OR, 2.30 (95% CI, 1.09-4.85) for the 1 to 2 risk alleles subgroup and adjusted OR, 2.82 (95% CI, 1.35-5.88) for the >2 risk alleles subgroup], compared with those without any risk alleles. However, no overall significant associations were observed between R668Q and lung cancer risk in this study population. These findings indicate that the potentially functional polymorphisms, MMP-9 P574R and R279Q, may confer the biomarker in the occurrence and metastasis of primary lung cancer. Further functional studies including these two genetic variants are warranted to confirm our findings.

P-279 A study on relationship between CD44V6 expression of peripheral blood lymphocyte and distant metastasis in primary lung cancer

P-279 A study on relationship between CD44V6 expression of peripheral blood lymphocyte and distant metastasis in primary lung cancer

A Case of Cavitary Pulmonary Metastases of Primary Cavitary Lung Cancer

Many disorders and abnormalities are accompanied by cavitary lesoin of the lung and one of the most common causes of cavitary lung disease are primary and metastatic lung neoplasms. but cavitary formation of primary lung cancer is not frequent and cavitary or cystic pulmonary metastases of this is also rare. We report a case of cavitary pulmonry metastases of primary lung cancer proven by bronchoscopic biopsy and chest CT. The patients was 60 year-old heavy smoker who had no known underlying lung diseases 7 years ago and complained chronic cough. The chest CT showed primary lung cancer in right low lobe with multiple cavitary or cystic metastases in both lungs and multiple lymphatic metastases.

Availability of markers of bone metabolism in the diagnosis of bone metastasis in primary lung cancer

Availability of markers of bone metabolism in the diagnosis of bone metastasis in primary lung cancer