Risk Factors For Pulmonary Metastasis Research Articles

Pneumonia promotes pulmonary metastasis of HCC after transplantation via VEGF regulated PI3K/AKT/Cas-9 signaling and angiogenesis

Aim: Pneumonia is the most frequent early postoperative complication in liver transplantation (LT) recipients. Inflammation may provide a favorable environment for tumor implantation, so we aimed to evaluate the impact of pneumonia on pulmonary metastasis of hepatocellular carcinoma (HCC) and reveal its underlying mechanism. Methods: A training cohort with 234 LT recipients were recorded and analyzed. Using the propensity-score method, we matched covariates between patients with and without pneumonia. A model for predicting pulmonary metastasis was built and validated in an independent validating cohort containing 179 subjects. A mouse model was built to mimic HCC pulmonary metastasis. The potential pathway was revealed by cytokine array analysis and validated in vitro . Results: Pneumonia was an independent risk factor for pulmonary metastasis in liver transplant recipients. It promoted pulmonary metastasis in both the clinical setting and the mouse model. In vitro , LPS-stimulated VEGF secretion from macrophages in the lung significantly reduced cell apoptosis and activated PI3K/AKT/cas-9 signaling. Administration of VEGF receptor2 inhibitor Vatalanib could reduce metastasis and improve prognosis in pneumonia mice. Conclusion: Pneumonia promotes HCC pulmonary metastasis by activating PI3K/AKT/Cas-9 signaling in HCC cells via macrophage-originated VEGF. Vatalanib might be efficient in reducing HCC pulmonary metastasis in liver transplant recipients with pneumonia.

Do resected colorectal cancer patients need early chest imaging? Impact of clinicopathologic characteristics on time to development of pulmonary metastases.

For patients with colorectal cancer (CRC), the lung is the most common extra-abdominal site of distant metastasis. However, practices for chest imaging after colorectal resection vary widely. We aimed to identify characteristics that may indicate a need for early follow-up imaging. We retrospectively reviewed charts of patients who underwent CRC resection, collecting clinicopathologic details and oncologic outcomes. Patients were grouped by timing of pulmonary metastases (PM) development. Analyses were performed to investigate odds ratio (OR) of PM diagnosis within 3 months of CRC resection. Of 1600 patients with resected CRC, 233 (14.6%) developed PM, at a median of 15.4 months following CRC resection. Univariable analyses revealed age, receipt of systemic therapy, lymph node ratio (LNR), lymphovascular and perineural invasion, and KRAS mutation as risk factors for PM. Furthermore, multivariable regression showed neoadjuvant therapy (OR: 2.99, p < 0.001), adjuvant therapy (OR: 6.28, p < 0.001), LNR (OR: 28.91, p < 0.001), and KRAS alteration (OR: 5.19, p < 0.001) to predict PM within 3 months post-resection. We identified clinicopathologic characteristics that predict development of PM within 3 months after primary CRC resection. Early surveillance in such patients should be emphasized to ensure timely identification and treatment of PM.

Non‑surgical outcomes and risk factors for pulmonary metastasis from giant cell tumor of bone.

The present study detailed four factors associated with an increased risk of pulmonary metastasis, age, pathological fracture, local recurrence and mode of treatment. Local recurrence and pathological fracture were independent risk factors for developing metastasis. From January 2016 to December 2021, data from 50 patients diagnosed with giant cell tumor of bone (GCTB) treated in Khon Kaen Hospital, Thailand, were retrospectively analyzed. The risk factors, including age at diagnosis, location of GCTB, clinical presentation, Campanacci stage and no. of local recurrences, for GCTB-induced pulmonary metastasis were evaluated using univariate and multivariable logistic regression analyses. Of the 50 patients analyzed, 9 patients (18%), with a mean age of 46.3 years (range, 18-68 years), developed pulmonary metastasis. No patients died from pulmonary metastasis in the present study. Statistically significant associations were observed between the development of metastasis and both clinical fracture [odds ratio (OR), 6.107; 95% confidence interval (CI), 1.08-34.70] and local recurrence (OR, 6.48; 95% CI, 1.03-40.87). Patients presenting with both a clinical fracture and local tumor recurrence require more rigorous clinical observation due to the significantly elevated risk of disease progression.

Prediction of pulmonary metastasis in esophageal carcinoma patients with indeterminate pulmonary nodules

BackgroundIndeterminate pulmonary nodules (IPNs) are common after surgery for esophageal cancer. The paucity of data on postoperative IPNs for esophageal cancer causes a clinical dilemma.ObjectiveThe aim of this study was to identify the characteristics and clinical significance of IPNs after radical esophagectomy for metastatic esophageal cancer, determine the risk factors for pulmonary metastasis, and construct a risk score model to standardize the appropriate time to either follow up or treat the patient.MethodsAll consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between 2013 and 2016 were included in this retrospective study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and develop risk score models.ResultsA total of 816 patients were enrolled in the study. During a median follow-up period of 45 months, IPNs were detected in 221 (27.1%) patients, of whom 66 (29.9%) were diagnosed with pulmonary metastases. The following five variables maintained prognostic significance after multivariate analyses: the pathologic N category, number of IPNs, shape of IPNs, time of detection of IPNs, and size of IPNs. The Pulmonary Metastasis Prediction Model (PMPM) scale ranges from 0 to 15 points, and patients with higher scores have a higher probability of pulmonary metastases. The Hosmer–Lemeshow test showed a good calibration performance of the clinical prediction model (χ2 = 8.573, P = 0.380). After validation, the PMPM scale showed good discrimination with an AUC of 0.939.ConclusionA PMPM scale for IPNs in patients who underwent esophagectomy for ESCC may be clinically useful for diagnostic and therapeutic decision-making.

Retracted: Risk Factors for Pulmonary Metastasis in Differentiated Thyroid Carcinoma Patients and the Significance of Changes in Matrix Metalloproteinase 13 and microRNA-142 Levels.

[This retracts the article DOI: 10.1155/2022/6820281.].

Do Resected Colorectal Cancer Patients Need Early Chest Imaging? Impact of Clinicopathologic Characteristics on Time to Development of Pulmonary Metastases

INTRODUCTION: Among patients with colorectal cancer (CRC), the lung is the most common extra-abdominal site for distant metastasis. In many circumstances, pulmonary metastasectomy can improve survival and result in cure. However, practices for post-resection chest imaging vary widely, without data-driven rationale for timing. We aimed to identify clinicopathologic characteristics that may indicate a need for early follow-up imaging. METHODS: We retrospectively reviewed patients who underwent CRC resection and collected clinicopathologic details from patients’ medical records and prospectively maintained surgical databases (2000-2017). Patients were grouped according to development of pulmonary metastases (PM) and timing of PM diagnoses. Univariable and binomial logistic regression were performed to investigate odds ratio (OR) of PM diagnosis within 3 months of CRC resection. RESULTS: Of 1600 patients with resected CRC, 233 (14.6%) developed PM, with time to PM occurring at a median of 15.4 months following CRC resection. Univariable analyses revealed age, receipt of systemic therapy (neoadjuvant or adjuvant), lymph node ratio, lymphovascular and perineural invasion, and KRAS mutation as risk factors for PM. Further, multivariable regression showed neoadjuvant therapy (OR: 2.99, 95% Confidence Interval [CI]: 1.62-5.52, p < 0.001), adjuvant therapy (OR: 6.28, CI: 2.92-13.49, p < 0.001), lymph node ratio (OR: 28.91, CI: 5.25-159.16, p < 0.001), and KRAS mutation (OR: 5.19, CI: 2.83-9.50, p < 0.001) to predict PM within 3 months (Table). CONCLUSION: We identified specific clinicopathologic characteristics which predict development of PM within 3 months after primary CRC resection. Early surveillance in such patients may be considered to ensure timely identification and opportunity for intervention. Table. - Multivariable Logistic Regression of Factors Associated with Development of Pulmonary Metastasis Clinicopathologic characteristics Odds ratio (95% CI) p Value Age (Increasing) 0.98 (0.95-1.00) 0.066 Neoadjuvant Chemotherapy 2.99 (1.62-5.52) <0.001 Adjuvant Chemotherapy 6.28 (2.92-13.49) <0.001 Lymph Node Ratio (Increasing) 28.91 (5.25-159.16) <0.001 KRAS Mutated 5.19 (2.83-9.50) <0.001

Risk Factors for Pulmonary Metastasis in Differentiated Thyroid Carcinoma Patients and the Significance of Changes in Matrix Metalloproteinase 13 and microRNA-142 Levels.

This work aims to explore the risk factors of lung metastasis (LM) in differentiated thyroid cancer (DTC) (LM-DTC) and the effect of treatment and to detect the relationship between LM-DTC and the levels of matrix metalloproteinase-13 (MMP-13) and micro ribonucleic acid (RNA)-142 (miR-142) in peripheral blood. The data of 420 patients with DTC who are admitted from March 2020 to December 2021 are collected and divided into a non-metastasis group (non-LM group) of 400 cases and metastasis group (LM group) of 20 cases according whether the mung metastasis is found. In addition, risk factors of LM-DTC are analysed and compared. The results of multivariate logistic analysis show that age, disease course, and imaging timing are independent influencing factors of the radionuclide treatment effect. Follicular carcinoma, abnormal expressions of MMP-13, and miR-142 can increase the risk of LM-DTC. MMP-13 and miR-142 can be undertaken as auxiliary diagnostic biological indicators.

Pulmonary metastasis of giant cell tumour: a retrospective study of three hundred and ten cases.

Giant cell tumour (GCT) is an invasive benign bone tumour, andthe incidence of pulmonary metastasis is rare. We are aiming to analyze risk factors of pulmonary metastasis and clinical prognosis for giant cell tumour patients with pulmonary metastasis. We performed a retrospective study of 310 patients with GCT between December 2004 and December 2016. Risk factors of pulmonary metastasis were analyzed by univariate and multivariate logistic regression analysis. Then, the influence of risk factors of overall LR (local recurrence), recurrent tumor at presentation, LR after our therapy, and with soft tissue mass on the pulmonary metastasis-free survival rates was analyzed. The mean follow-up of the present cohort was 45.6 ± 35.3months (median, 36.6months; range, 6.1-193.4months). Eighteen (5.8%) of 310 patients developed pulmonary metastasis. The average interval from surgery of primary tumour to detection of pulmonary metastasis was 15months. Multivariate logistic regression analysis showed overall local recurrence was the independent risk factor of developing pulmonary metastasis. Among 18 patients with pulmonary metastasis, sixteen cases had history of local recurrence (88.9%, 16/18), including eleven (68.8%, 11/16) with local recurrence at presentation before receiving our therapy and seven (43.8%, 7/16) with local recurrence after receiving treatment in our hospital. Time to local recurrence had obvious difference between patients with and without pulmonary metastasis. Patients with pulmonary metastasis were prone to recur earlier. Furthermore, overall local recurrence, local recurrence after our therapy, recurrent tumor at presentation, and tumour witha soft tissue mass showed statistical differences in the pulmonary metastasis-free survival rates. Giant cell tumour patients with soft tissue mass and overall local recurrence are prone to develop pulmonary metastasis. Although giant cell tumour is a benign tumor, more attention should be paid to the problem of pulmonary metastatic lesions, and chest CT scan should be recommended during follow-up.

A review of staging chest CT in trunk and extremity soft tissue sarcoma.

To determine the incidence of pulmonary metastases on chest CT in trunk and extremity soft tissue sarcoma based on two size criteria, and to identify factors associated with metastases. Retrospective review of chest CT studies in patients with trunk and extremity soft tissue sarcoma over an 18-month period. Data collected included patient age/sex, tumour location, size and relationship to fascia. All chest CTs were reviewed for the presence of metastases which were diagnosed according to two size criteria: multiple nodules > 5 mm in size or multiple nodules > 10 mm in size. Follow-up CT studies were reviewed in cases initially considered indeterminate. 127 males and 73 females were included (mean age 57.1 years; range 10-90 years). 147 (73.5%) tumours were deep to the fascia and 53 (26.5%) superficial. Tumour size classified according to the 12 AJCC 2019 criteria was: T1 = 52, T2 = 76, T3 = 39, T4 = 33. Based on nodule size >5 mm, 73 (36.5%) patients had no metastases, 42 (21%) had metastases, while 85 (42.5%) studies were indeterminate. Based on nodule size >10 mm, 73 (36.5%) patients had no metastases, 28 (14%) had metastases, while 99 (49.5%) studies were indeterminate. Larger maximum dimension of the primary tumour was a risk factor for pulmonary metastases using both size criteria. The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14-21%. 42.5-49.5% of chest CTs were indeterminate. The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14-21%. Indeterminate pulmonary nodules are also very common.

The Impact of Smoking on Pulmonary Metastasis in Colorectal Cancer.

IntroductionRecently, clinical studies have revealed that smoking can contribute to the poor prognosis of colorectal cancer (CRC) and, additionally, can be a risk factor for pulmonary metastasis of CRC. However, there has been no basic research regarding the underlying molecular mechanism. The purpose of this study was to clarify the mechanism by which smoking causes pulmonary metastasis of CRC.MethodsFirst, pulmonary metastasis model mice inhaled cigarette smoke or air (control) for 1 h once a day for 3 weeks. We attempted to clarify the effect of smoking on the incidence of pulmonary metastasis. On the 15th day, CMT-93 cells were injected into the tail vein. At 6 and 8 weeks following injection, the extent of pulmonary metastasis was evaluated using in vivo micro CT. After the last CT examination, the mice were sacrificed, and the lungs were extracted for pathological examination.ResultsThe number of mice with pulmonary metastases in the smoking group was significantly higher than in the control group. Three weeks of smoking induced mild inflammation in the lungs, as evidenced by increases in the levels of IL-6 and TNF-α in bronchoalveolar lavage. Moreover, the adhesion-related molecule ICAM-1 was overexpressed in pulmonary tissue, which allowed drained cancer cells to remain in the lung and contribute to the formation of pulmonary metastasis.ConclusionCollectively, cigarette smoking may contribute to the pathogenesis and development of pulmonary metastasis in CRC through enhancement of adhesion and inflammation.

Effects of Anesthetic Technique on Postoperative Pulmonary Metastasis in Patients Undergoing Laryngectomy.

BackgroundWhether laryngeal cancer is directly implanted into the lungs during orotracheal intubation is still unclear. Therefore, this study aimed to find whether orotracheal intubation is an independent risk factor for postoperative pulmonary metastasis in patients undergoing laryngectomy.Patients and MethodsMedical records from January 1, 2006, to December 31, 2016, were reviewed. According to similar propensity scores, patients who received orotracheal intubation (tracheal intubation group, n = 515) were matched 1:1 with those who received tracheotomy (tracheotomy group, n = 326) in the induction of general anesthesia. The primary outcome was postoperative pulmonary metastasis. Secondary outcomes included local recurrence, lymphatic metastasis, tracheostomal recurrence and overall survival.ResultsBetween the two groups, there was no significant difference in postoperative pulmonary metastasis (P = 0.688), local recurrence (P = 0.215), lymphatic metastasis (P = 0.480), tracheostomal recurrence (P = 0.246) or all-cause death (P = 0.299). The primary site of cancer was an independent risk factor for pulmonary metastasis [HR 0.29, 95% CI 0.13–0.68; P = 0.013] and local recurrence (HR 2.69, 95% CI 1.39–5.21; P = 0.003). Type of surgery (HR 3.13, 95% CI 2.03–4.84; P < 0.001) and N classification of TNM (HR 0.27, 95% CI 0.10–0.75; P = 0.012) were risk factors for local recurrence. Postoperative chemotherapy was an independent risk factor for lung metastasis (HR 7.58, 95% CI 3.11–18.47; P < 0.001) and lymphatic metastasis (HR 5.18, 95% CI 2.57–11.91; P < 0.001), and 5-year overall survival was associated with age (P = 0.028), clinical stage (P < 0.001) and postoperative chemotherapy (P = 0.003) but not with anesthetic technique (P = 0.473).ConclusionThis retrospective study suggests that orotracheal intubation in laryngectomy is not a risk factor for postoperative pulmonary metastasis, local recurrence, lymphatic metastasis or overall survival.

Prognosis and risk factors for the development of pulmonary metastases after preoperative chemoradiotherapy and radical resection in patients with locally advanced rectal cancer

Although preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is currently considered effective for treating locally advanced rectal cancer (LARC), a proportion of patients develop postoperative pulmonary metastases. The current study aimed to assess the prognostic characteristics and risk factors for the development of rectal cancer pulmonary metastases after CRT and radical resection. We retrospectively analyzed data collected on 544 consecutive patients who were diagnosed with LARC and underwent preoperative CRT followed by tumor radical resection between December 2003 and June 2014. Overall survival (OS), disease-free survival (DFS), and pulmonary metastasis rates were calculated and compared among the subgroups, and risk factors for pulmonary metastases were identified by Cox models. A total of 61 (11.2%) patients developed pulmonary metastases postoperatively, 45 of whom (73.8%) developed the condition in the first 24 months. The 1-, 2-, and 3-year pulmonary metastasis rates were 6.7%, 10.4%, and 11.7%, respectively. Compared with the disease-free group, the pulmonary metastases group had a significantly lower proportion of downstaging and pathological complete regression (pCR) rate and a significantly higher proportion of low rectum tumor. In multivariate analysis, a distance of the tumor ≤5 cm from the anal verge [hazard ratio (HR), 1.394; 95% confidence interval (CI), 1.211-3.736; P=0.003] was identified as an independent negative predictor of the 3-year pulmonary metastasis rate, and N0 stage (HR, 0.490; 95% CI, 0.261-0.919; P=0.026) and TNM downstaging (HR, 0.514; 95% CI, 0.265-0.997; P=0.049) were identified as independent positive predictors of the 3-year pulmonary metastasis rate. Pulmonary metastases warranted a more intensive follow-up in patients with low rectal cancer, lymph node metastases and poor response after preoperative CRT and radical tumor resection.

Risk and prognostic nomograms for hepatocellular carcinoma with newly-diagnosed pulmonary metastasis using SEER data

PurposeThis research aimed to identify risk factors of pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) and prognostic factors of patients with PM from HCC at initial diagnosis.MethodsPatients diagnosed with HCC between 2010 and 2015 were reviewed retrospectively in the Surveillance, Epidemiology, and End Results (SEER) database. Patients with PM from HCC at initial diagnosis were identified from the entire cohort. Predictors for PM from HCC were identified by multivariate logistic regression analysis. Independent prognostic factors for patients with PM were determined by univariate and multivariate Cox regression analysis. Nomograms were also constructed for quantifying risk of metastasis and overall survival estimation visually.ResultsOur research included 30,641 patients diagnosed with HCC, of whom 1,732 cases were with PM from HCC at initial diagnosis. The risk factors causing PM from HCC were age (P = 0.001), race (P < 0.001), primary tumor size (P < 0.001), T stage (P < 0.001), N stage (P < 0.001), alpha-fetoprotein (P < 0.001), bone metastasis (P < 0.001), brain metastasis (P < 0.001), and intrahepatic metastasis (P < 0.001). The significantly prognostic factors for overall survival were age (P = 0.014), T stage (P = 0.009), surgical approach (P < 0.001), and chemotherapy (P < 0.001). Harrell’s C-index statistics of two nomograms were 0.768 and 0.687 respectively, indicating satisfactory predictive power.ConclusionsThis research provided evaluation of risk factors and prognosis for patients with PM from HCC. Two nomograms we developed can be convenient individualized tools to facilitate clinical decision-making.

Prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma who have undergone radical nephrectomy.

The aim of the present study was to validate prognostic indicators of pulmonary metastasis in patients with renal cell carcinoma (RCC) that have undergone nephrectomy treatment. The data from 356 patients who underwent nephrectomy were investigated and subsequently divided into 2 groups, according to the pulmonary metastasis status. The risk factors for pulmonary metastasis were examined in all patients. In the subgroup analysis, the risk factors were additionally verified in patients with pulmonary nodules using univariate and multivariate logistic regression analyses. The status of pulmonary nodules and pulmonary metastasis were confirmed through preoperative chest radiography by two radiologists. Pulmonary metastasis was observed in 33 (9.3%) patients with a median follow-up time of 54.4 months (interquartile range, 38.8-71.8). Patients with pulmonary nodules indicated significantly increased rates of pulmonary metastasis, compared with patients without pulmonary nodules (24.2 vs. 6.1%; P<0.001). In multivariate analysis, the presence of pulmonary nodules [hazard ratio (HR)=3.15; P=0.0262], albumin (HR=0.42; P=0.0490) and pTstage (HR=3.63; P=0.0475) were indicated to be independent prognostic markers for pulmonary metastasis. In subgroup analysis, pTstage was the only independent prognostic indicator for pulmonary metastasis in these patients (HR=9.81; P=0.0033). In patients with RCC, the presence of pulmonary nodules was associated with pulmonary metastasis. Furthermore, pTstage is a negative prognostic indicator in patients with pulmonary nodules. Therefore, a chest radiologic short-term follow-up is required for these patients.

Spread through air spaces in lung cancer patients is a risk factor for pulmonary metastasis after surgery.

Spread through air spaces (STAS) is regarded as a significant risk factor for lung cancer recurrence. STAS consists of micropapillary clusters, solid nests, or single cells beyond the edge of the tumor into air spaces in the surrounding lung parenchyma. However, the patterns of lung cancer recurrence have not been clarified in patients with STAS. The aim of this study was to explore STAS and recurrence patterns in patients who underwent lung cancer surgery. Between January 2000 and December 2017, a total of 1,426 patients underwent complete resection of lung cancer. We studied 848 patients with pathological stage I disease who underwent surgery. Recurrence patterns and recurrence-free rates were determined from pathological findings, particularly the presence of STAS. Locoregional recurrences included surgical margin recurrences, hilar and mediastinal lymph node metastases, ipsilateral lobe metastases, and pleural dissemination, whereas distant recurrences included extrathoracic organ and contralateral lobe metastases. STAS was observed in 139 of 848 (16.4%) cases. Recurrences developed in 108 (12.7%) cases: locoregional recurrences in 76 (9.0%), distant metastases in 27 (3.2%), and both in 5 (0.6%) cases. Among recurrences, pleural dissemination developed in 12 (1.4%) and pulmonary metastases in 46 (5.4%) cases. Five-year recurrence-free rates were 65.4% among patients with STAS and 89.0% among patients without STAS. Univariate and multivariate analyses revealed that STAS was a significant risk factor for recurrence (P<0.001), particularly locoregional recurrence (P=0.005). In addition, STAS was a significant risk factor for pulmonary metastasis (P=0.009). Among pathological stage I patients who undergo complete resection of lung cancer, patients with STAS tend to develop locoregional recurrence and pulmonary metastases.

Development and validation of a prognostic index to predict pulmonary metastasis of giant cell tumor of bone

PurposeGiant cell tumor of bone (GCTB) is an intermittent tumor with a low probability of pulmonary metastasis. Our aim was to investigate the risk factors and establish a nomogram predictive model for GCTB pulmonary metastasis.MethodsWe retrospectively evaluated GCTB patients at our center from 1991 to 2014. The cohort was randomized into training and validation sets. Univariate and multivariate analyses were used to evaluate the risk factors of pulmonary metastasis. A nomogram was established. Internal validation was achieved based on ROC curve and C-index values in the validation set. Decision curve analysis was performed to assess the clinical performance of the nomogram.Results417 patients were studied, including benign and malignant GCTBs. The average follow up was 79 months. Pulmonary metastases were observed in 27 cases. Four independent risk factors were identified: malignancy, tumor bearing time, times of recurrence and tumor size. A nomogram was developed to predict pulmonary metastasis with C-index values of 0.857 and 0.785 in the training and validation groups. In the decision curve analysis, patients could benefit from the nomogram, which differentiates patients at high risk for pulmonary metastasis and avoids unnecessary examination. According to the nomogram, patients with final risks of more than 0.06 should be scheduled for further chest scans.ConclusionMalignancy, tumor bearing time, times of recurrence and tumor size were independent risk factors for pulmonary metastasis in GCTB patients. The nomogram can accurately predict the risk of pulmonary metastasis and help doctors to make clinical decisions for further chest examinations.

P114 - Risk factors of pulmonary metastasis in localized renal cell carcinoma patients with pulmonary nodules

P114 - Risk factors of pulmonary metastasis in localized renal cell carcinoma patients with pulmonary nodules

Possible Risk Factors of Pulmonary Metastases in Patients With International Federation of Gynecology and Obstetrics Stage I Endometrioid-Type Endometrial Cancer.

Limited data have been obtained in regard to pulmonary metastasis (PM) in patients with stage I endometrial cancer. The aims of the study were (1) to present the clinical and pathological characteristics of patients with PM in the setting of stage I endometrioid-type endometrial cancer (EEC) and (2) to define possible factors that may be used to predict PM. Six hundred thirty patients with stage I EEC, including 12 with PM, 19 with extra-PM (EPM), and 599 with no recurrence, were observed. Paired samples of primary and metastatic tumors from a patient were used for exome sequencing to identify potential gene mutations associated with PM. There was no significant difference in the age, Ki-67, lymphatic vascular space invasion, and grade 3 among the 3 groups (P > 0.05). More squamous epithelial differentiation was observed in PM (7/12), as compared with patients with EPM (1/19) (P < 0.05) and no recurrence (20/599) (P < 0.05). The tumor size of the patients with PM was bigger than that of nonrecurrent patients (29.8 ± 16.6 vs 18.5 ± 16.3 mm, P < 0.05). More percentage of patients with deep myometrial invasion (IB) were found in PM (6/12) (P < 0.05) as compared with patients with EPM (3/19) (P < 0.05) and no recurrence (76/599). CDH10, ARID1A, and EMT-associated gene mutations were identified in metastatic tumor tissue but not in primary tumors from a patient with EEC and lung metastases. Squamous epithelial differentiation, large tumor size, and deep myometrial invasion might be risk factors for PM in patients with stage I EEC. CDH10, ARID1A, and EMT-associated gene mutation may promote the initiation of lung recurrence. However, further studies are needed to determine the precise mechanisms associated with lung metastasis in these patients.

Clinical analysis of thyroid papillary carcinoma and risk factors of pulmonary metastasis in children

Objective Investigated the clinical features and risk factors of pulmonary metastasis in children with papillary thyroid carcinoma aiming to provide guide for clinical work. Methods Collected the informations of 40 patients with under the age of 14, who underwent surgery in the Thyroid surgery of the First Affiliated Hospital of ZhengZhou University and confirmed for the papillary thyroid carcinoma by the postoperative pathology. At the same time, excluded studies with history of head and neck malignancy or lyphoma or secondary thyroid cancer, papillary thyroid carcinoma with hyperthyroidism and cases of imcomplete informations. The age of the 40 patients was 3 to 14 years old, 12 were boy and 28 were girl. The largest tumor diameter was 7.5 cm, and the smallest was 0.3 cm. Tumor lesions were solitary in 22 cases and multiple lesions were in 18 cases. There were 33 cases of cervical lymph node metastases and 7 cases of no cervical lymph nodes. There were 10 cases of pulmonary metastasis and 30 cases of non-pulmonary metastasis. This research adopted chi-square test and Logistic regression statistical analysis of related risk factors and clinical features, including patients′ age, gender, tumor diameter, number of lesions, surgical methods, neck lymph node metastasis, and pulmonary metastasis. Results The positive rate of plumonary metastsis in children with papillary thyroid carcinoma was 25% (10/40), statistical analysis found that the positive rate of children with lung metastasis (χ2=8.620, P=0.003), tumor diameter over 2 cm (χ2=5.763, P=5.763) and the difference was statistically significant higher. Logistic regression analysis showed that the number of risk factors was multifocal papillary thyroid carcinoma in children lung metastasis(OR=13.058, P=0.028). Conclusions Higher lung metastasis is a clinical feature of thyroid papillary carcinoma in children. The risk of lung metastasis was significantly higher for children with thyroid papillary carcinoma who had multiple lessions. Key words: Child; Thyroid neoplasms; Logistic models

Clinical characteristics and risk factors analysis of lung metastasis from benign giant cell tumor of bone

Pulmonary metastasis of benign giant cell tumor of bone is very rare, and its biological behavior is difficult to predict. In the present study, we analyzed the clinical characteristics of and related risk factors for pulmonary metastasis from this tumor. Forty-six patients with lung metastasis were analyzed. In total, 60.9% of the primary tumors were located around the knee joint. The Campanacci stage of all tumors was stage 3. Surgery of the primary tumor included curettage in 37 patients, resection in 8, and amputation in 1. Local recurrence after the primary surgery occurred in 34 patients. The recurrence rate, Campanacci stage, and surgical method were significant risk factors for lung metastasis. The median postoperative metastasis times in the lower limbs, upper limbs, and axial skeleton were 20.1, 7.9, and 1.4 months, respectively (p=0.010). The median metastasis times in patients with and without recurrence were 13.7 and 43.2 months, respectively (p=0.018). Eighteen patients had unilateral metastasis and 28 had bilateral metastasis. Most lesions (n=38) were located in the peripheral lung. Nineteen patients received treatment, and 12 of them underwent tumor resection. The 5-year overall survival rate was 94.4%. This study showed that local recurrence, a high Campanacci stage, and curettage were possible high-risk factors for pulmonary metastasis. The primary lesion site and local recurrence may be related to the metastasis time. The survival rate of patients with pulmonary metastasis was high.