Synchronous Metastases Research Articles

Survival analysis and prognostic factors of palliative radiotherapy in patients with metastatic colorectal cancer: a propensity score analysis.

Radiation therapy (RT) is known to have beneficial effects on the palliative treatment of patients with advanced cancer. However, valid data on this treatment method are limited, especially for patients with metastatic colorectal cancer (mCRC). This study aimed to identify prognostic factors and investigate the outcomes of mCRC patients who received palliative RT. A total of 488 mCRC patients who underwent systemic therapy with or without palliative RT between 2014 and 2019 were included in the study. Of the 488 patients, 155 received systemic treatment combined with palliative RT (RT group), while 333 were only administered systemic treatment (non-RT group). Propensity score matching (PSM) was conducted to eliminate possible bias, and overall survival (OS) was calculated using the Kaplan-Meier (KM) method. A log-rank test was used to compare the survival outcomes of each group, and a multivariate analysis was conducted using a Cox proportional hazards model. The RT group had a higher OS than that of the non-RT group (P=0.001). After PSM, the median OS of the RT group was 50.8 months, and for the non-RT group it was 32.2 months (P=0.003). Subgroup analysis revealed that RT had a better effect on the OS of patients who had synchronous metastasis, or who didn't receive targeted therapy or local treatment (including surgery, ablation, and intervention). Multivariate analysis of the whole cohort showed that palliative RT was associated with improved OS. Moreover, multivariate analysis of the RT group showed that systemic therapy before RT, and the site of RT was in the liver and lung, were independent prognostic factors affecting survival time. We demonstrated that systemic treatment followed by palliative RT led to a better OS for mCRC patients. This combination method can therefore be seen as a suitable treatment approach for patients with mCRC.

INCIDENTAL SOLE CONTRALATERAL PLEURAL METASTASIS FROM RENAL CELL CARCINOMA SEVEN YEARS POST NEPHRECTOMY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Renal cell carcinoma (RCC) accounts for 3% of all adult male cancers, and half of them are incidental findings on imaging [1]. 18% of patients have synchronous metastasis at RCC diagnosis, and 85% have metachronous metastasis within five years after surgery. A better prognosis is seen with a metachronous metastasis occurring after a long disease-free interval [2] CASE PRESENTATION: A 68-year-old male presented to an outside emergency department with generalized weakness, fatigue, and loss of appetite for a week's duration with no respiratory complaints. He was a former smoker who quit 40 years back. He had significant asbestos exposure as a sandblaster and changing railroad brake shoes. His initial blood work revealed an acute kidney injury with a serum creatinine of 14.8 mg/dL with no leukocytosis. Computed tomography (CT) abdomen revealed an obstructive right ureteropelvic junction stone (1.4 x 1 cm) with moderate hydronephrosis. Chest x-ray and CT revealed multiple right pleural soft tissue masses (largest measuring 7.7 x 3.1 x 3.5 cm) with no effusion concerning for malignancy (Figure A). Past medical history was significant for left clear cell RCC grade 3/4 with no invasion (T1bNxMx) treated by left radical nephrectomy seven years ago. His obstruction was relieved by urological intervention. A nuclear positron emission tomography showed hypermetabolic right pleural masses and a right paratracheal lymph node (Figure B). A CT-guided biopsy returned positive for metastatic RCC (Figure C1-C2). His creatinine improved, and he was discharged with an oncology follow-up DISCUSSION: The risk of RCC metastasis via hematogenous or lymphatic spread increases if it is locally advanced (stage 3-4), higher nuclear grade, and clear cell histology [2]. The lung is the frequent site of metastasis (45%), and pleural lesions occur in 12% along with lung spread [3]. Isolated pleural spread without an effusion is rare. Dormant metastasis uses Batson's venous plexus draining into thoracic veins (bronchial and intercostal) and reaches the pleura rather than by lung parenchyma direct extension [2]. Most reported cases of solitary pleural spread are symptomatic with effusion. Our patient was asymptomatic with incidental contralateral pleural metastasis without pleural effusion seven years postresection with a rare combination of pleural and paratracheal lymph node spread. 5-15% of patients recur with a distant spread questioning the current five-year surveillance strategy [4] CONCLUSIONS: Metastatic RCC to the pleura is a rare finding. This diagnosis should be considered in patients with RCC history, even if the presentation is many years after initial diagnosis and treatment. Postnephrectomy, the surveillance should be based on an individual's RCC risk factors REFERENCE #1: Ohnishi H, Abe M, Hamada H, et al. Metastatic renal cell carcinoma presenting as multiple pleural tumours. Respirology. 2005;10(1):128-31 REFERENCE #2: Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 2013;33(6):1691-716 REFERENCE #3: Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer. 1981;48(6):1487-91 DISCLOSURES: No relevant relationships by Mohammed Alnijoumi, source=Web Response No relevant relationships by Cliff Chen, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response

ES02.04 Systemic Therapy Influenced Trials in Oligometastatic Disease

A working definition of Oligometastatic Disease (OMD) in Non-Small Cell Lung Cancer (NSCLC) is no more than 5 metastases involving 3 organs 1. This definition of OMD is largely for the purposes of offering local ablative therapy (LAT) - which includes surgery, or more frequently radiotherapy and, in particular Stereotactic Ablative Body Radiotherapy (SABR). However, OMD is a heterogenous state – which encompasses many clinical scenarios: at diagnosis of NSCLC with synchronous metastases; at recurrence after effective therapy; at progression after systemic therapy; and persistent site (s) of disease on therapy.

S1626 Youngest Reported Case of Colonic Adenocarcinoma With Synchronous Metastasis to the Pancreas

S1626 Youngest Reported Case of Colonic Adenocarcinoma With Synchronous Metastasis to the Pancreas

The Epidemiology of Lung Metastases.

Introduction: Lung metastasis is usually associated with poor outcomes in cancer patients. This study was performed to characterize and analyze the population of patients with de novo (synchronous) lung metastases using the Surveillance, Epidemiology and End Results (SEER) database.Materials and Methods: Baseline characteristics of lung metastasis patients were obtained from SEER case listings. Incidence rates and counts of synchronous lung metastasis were also obtained using the SEER*Stat software. Survival outcomes were analyzed using univariate and multivariable Cox regressions, controlling for confounders. An alpha threshold of 0.05 was used for statistical significance and p-values were subject to correction for multiple comparisons.Results: The age-adjusted incidence rate of synchronous lung metastasis was 17.92 per 100,000 between 2010 and 2015. Synchronous lung metastases most commonly arose from primary lung cancers, colorectal cancers, kidney cancers, pancreatic cancers and breast cancers. During this time period, 4% of all cancer cases presented with synchronous lung metastasis. The percentage of patients presenting with synchronous lung metastasis ranged from 0.5% of all prostate cancers to 13% of all primary lung cancers. The percentage of all cancer cases presenting with synchronous lung metastasis increased over time. De novo metastatic patients with lung metastases had worse overall survival [hazard ratio = 1.22 (1.21–1.23), p < 0.001] compared to those with only extrapulmonary metastases, controlling for potential confounders.Conclusions: Synchronous lung metastasis occurs frequently and is an independent predictors of poor patient outcomes. As treatment for lung metastases becomes more complicated, patients with synchronous lung metastasis represent a high-risk population.

Long-Term Outcomes and Causes of Death among Medullary Thyroid Carcinoma Patients with Distant Metastases.

Simple SummaryThe prognostic significance of metastatic sites, and immediate cause of death in MTC patients with distant metastasis remains unclear. In this study, we calculated the time from metastasis to death, and we found that long-term oncologic outcomes were differ from initial metastatic site; the hazard ratio for bone metastatic sites (HR: 5.42; p = 0.044) and multisite metastasis (HR: 6.11; p = 0.006) were significantly higher than for lung metastasis. Complications due to the progression of distant metastasis were the most common cause of death, followed by complications related to chemotherapy and airway obstruction.Distant metastasis is a poor prognostic factor in medullary thyroid carcinoma (MTC), but the significance of differentiating the characteristics according to the site of distant metastasis remains unclear. This study aimed to evaluate the clinical characteristics and long-term oncologic outcomes in MTC patients with distant metastasis. We identified 46 MTC patients with distant metastasis between 1994 and 2019. Clinical characteristics were compared based on the timing of the detection of distant metastasis. Additionally, survival rates following the detection of distant metastasis were evaluated to compare the clinical significance of metastatic site. The detailed causes of death were also investigated. Of the 46 patients, 15 patients (32.6%) had synchronous distant metastasis and 31 patients (67.4%) had metachronous distant metastasis. There was no clinical difference between these two groups except regarding initial surgical extent. The lung (52.2%) was the most common metastatic site, followed by the bone (28.3%), mediastinum (19.6%), liver (17.4%), adrenal gland (4.3%), brain (4.3%), kidney (2.2%), and pancreas (2.2%). Patients with bone metastasis and multisite metastasis had significantly worse prognoses than those with lung metastasis (hazard ratio: 5.42; p = 0.044 and hazard ratio: 6.11; p = 0.006). Complications due to the progression of distant metastasis, airway obstruction due to tracheal invasion, and complications related to chemotherapy were leading causes of death. In conclusion, there was no difference in clinical characteristics according to the timing of distant metastasis. Oncological outcomes differed by metastatic site.

Prognostic impact of neoadjuvant chemotherapy in patients with synchronous colorectal liver metastasis: A propensity score matching comparative study

BackgroundSynchronous colorectal liver metastasis (SCRLM) is at an advanced tumor stage and requires multidisciplinary treatments. Neoadjuvant chemotherapy (NAC) is thought to be an effective treatment modality, but its prognostic impact is still unclear. Materials and methodsPatients with resectable SCRLM presented to eight university hospitals between 2007 and 2017 were retrospectively reviewed. Propensity score matching (PSM) was performed to adjust baseline characteristics between patients who received NAC with those who underwent up-front hepatectomy. The prognostic impact of NAC was then evaluated. ResultsThe cohort comprised of 320 patients: 151 patients received NAC and the remaining 169 patients underwent up-front hepatectomy. After a 1:1 ratio of PSM, 102 patients per group were selected. Within the PSM cohort, 66% patients had multiple liver tumors, with 15% having five or more liver tumors. The median survival (95% confidence interval) periods for patients with and without NAC in the PSM cohort were 88.5 (68.4 – not reached) and 84.2 (52.1 – not reached) months, respectively (P = 0.51). On multivariate analysis, the postoperative events in these patients including operative complications and use of adjuvant chemotherapy after hepatectomy were prognostic factors with hazards (95% confidence interval) being 1.88 (1.18–2.98) and 0.65 (0.42–1.01), respectively. ConclusionThis PSM study was restricted to patients with SCRLM and relatively advanced tumor stagings. NAC did not show any significant prognostic impact. While operative complications had a significant prognostic impact, use of adjuvant chemotherapy after hepatectomy had only a marginal prognostic impact. Reconsideration of indications for NAC is needed.

Radiation Therapy in Conjunction With Surgical Stabilization of Impending or Pathologic Fractures Secondary to Metastasis: Is There a Difference Between Single and Multifraction Regimens?

PurposePatients who undergo surgical stabilization for impending or pathologic fractures secondary to metastasis are often treated with radiation therapy to the involved site. We sought to retrospectively analyze outcomes from single versus multifraction regimens of radiation therapy in this setting. Methods and MaterialsFrom our institutional radiation database, we identified 87 patients between 2004 and 2016 who had an impending or pathologic fracture from metastatic disease and who underwent surgical fixation in conjunction with either neoadjuvant (within 5 weeks before surgery) or adjuvant (within 10 weeks after surgery) radiation therapy, representing 99 total treatment sites. Patients were included on the basis of intention to treat with bimodality therapy. Baseline patient characteristics were compared using 2-sided t tests and Fisher's exact tests. Cumulative incidence of local failure, reirradiation, and reoperation were calculated using the Fine-Gray method for competing risks. Freedom from complication was calculated using the Kaplan-Meier method. ResultsBaseline characteristics between the single (n = 52) and multifraction (n = 47) cohorts were similar with the exception of higher rates of synchronous bony metastasis (83% vs 60%, P = .01) and female patients (71% vs 43%, P = .004) in the single fraction cohort. There was no significant difference in overall survival between treatment groups. After a median follow-up of 13 months, there was no significant difference in the single and multifraction cohorts, respectively, in the 1-year cumulative incidence rates of local failure (4% vs 7%, P = .58), reirradiation (5% vs 4%, P = .95), reoperation (4% vs 0%, P = .30), or 1-year freedom from complication (90% vs 95%, P = .40). ConclusionsThis is the first study comparing outcomes between single and multifraction radiation therapy in conjunction with surgical stabilization of an impending or pathologic fracture. We found no difference in outcomes between single and multifraction regimens in this setting. Given these findings, single fraction perioperative radiation therapy may be a viable treatment option in appropriately selected patients pending prospective validation of these findings.

New Technique of Laparoscopic Paraaortic Lymph Node Dissection for Colorectal Cancer Using Fluorescence Navigation.

According to limited current reports, therapeutic paraaortic lymph node (PALN) dissection with intensive combined therapy for colorectal cancer improves prognosis in select patients. Laparoscopic PALN dissection is a difficult technique that has not yet been established. We applied this procedure using an intraoperative fluorescence navigation technique with a near-infrared ray catheter (NIRC™) fluorescent ureteral catheter (NIRFUC). We evaluated the utility of laparoscopic fluorescence navigation and the short-term outcomes of 6 patients undergoing laparoscopic PALN dissection. There were 3 surgeries for synchronous metastasis and 3 surgeries for recurrent metastasis. The mean surgical duration, blood loss, and postoperative hospital stay were 677 (range=518-1,090) min, 7.5 (range=3-1,600) ml, and 14 (range=9-33) days, respectively. Postoperative complications (Clavien-Dindo grade >III) occurred in 1 case. Dissection around the ureter was navigated with a NIRFUC. Fluorescence ureteral navigation facilitated completion of the complex laparoscopic PALN dissection procedure.

665P Role of prior nephrectomy for synchronous metastatic renal cell carcinoma (mRCC) on efficacy in patients treated with avelumab + axitinib (A + Ax) or sunitinib (S): Results from JAVELIN Renal 101

Cytoreductive nephrectomy (neph) remains controversial in the management of patients (pts) with mRCC; the role of prior neph in pts treated with immune checkpoint inhibitor remains unknown. In this extended follow-up analysis of the phase III JAVELIN Renal 101 trial (NCT02684006), we assessed the role of prior neph in pts with mRCC presenting with synchronous metastases at the time of diagnosis and treated with A + Ax or S.

Spatiotemporal Patterns of Loco-Regional Recurrence After Breast-Conserving Surgery.

BackgroundLoco-regional recurrences (LRR) following breast-conserving surgery (BCS) remain a heterogeneous class of disease that has significant variation in its biological behavior and prognosis.MethodsTo delineate the spatiotemporal patterns of LRR after BCS, we analyzed the data of 4325 patients treated with BCS from 2006 to 2016. Clinico-pathological and treatment specific factors were analyzed using the Cox proportional hazards model to identify factors predictive for LRR events. Recurrence patterns were scrutinized based on recurrence type and recurrence-free interval (RFI). Annual recurrence rates (ARR) were compared according to recurrence type and molecular subtype.ResultsWith a median follow-up of 66 months, 120 (2.8%) LRRs were recorded as the first site of failure. Age, pathologic stage, and molecular subtype were identified as predictors of LRR. The major recurrence type was ipsilateral breast tumor recurrence, which mainly (83.6%) occurred ≤5y post surgery. In the overall population, ARR curves showed that relapse peaked in the first 2.5 years. Patients with regional nodal recurrence, shorter RFI, and synchronous distant metastasis were associated with a poorer prognosis. HER2-positive disease had a higher rate of LRR events, more likely to have in-breast recurrence, and had an earlier relapse peak in the first 2 years after surgery.ConclusionsLRR risk following BCS is generally low in Chinese ethnicity. Different recurrence patterns after BCS were related to distinct clinical outcomes. Management of LRR should be largely individualized and tailored to the extent of disease, the molecular profile of the recurrence, and to baseline clinical variables.

Prediction of Recurrence Risk in Solid Pseudopapillary Neoplasm of the Pancreas: Single-Institution Experience.

Background: Solid pseudopapillary neoplasm (SPN) of the pancreas is a low-grade malignant neoplasm with unpredictable behavior. Factors associated with recurrence were not conclusively identified. The aim of this study is to define the clinicopathological criteria for recurrence risk prediction in SPNs based on the most recent scientific evidence and to present our experience with SPNs.Methods: A retrospective review of patients with SPNs operated on in our institution from June 2012 to June 2018 was completed. Patient characteristics and clinical outcomes were analyzed. A detailed literature review was performed to evaluate the factors associated with the recurrence of SPNs.Results: The cohort consisted of 13 female patients with a median age of 24 years and a mean tumor size of 7.7 cm. Body and tail (53.8%) were the most common location, and distal pancreatectomy with splenectomy was the prevalent surgical procedure. One patient of SPN operated on for local recurrence after 11 years which had high-grade malignant histological features on the previously resected tumor. At a median follow-up of 42 months (range 36 to 108), all patients were disease free and alive. The proposed criteria for predicting recurrence in SPNs include tumor size >8 cm, synchronous metastasis, malignant SPN (according to 2000 or 2010 World Health Organization [WHO] criteria), lymphovascular invasion, pancreatic parenchymal invasion, and high Ki-67 index (>4%). All these are worse prognostic factors and should be considered as high-risk factors for postoperative relapse.Conclusion: The above-mentioned criteria can better predict SPN recurrence. Patients with high-risk features should undergo an extended follow-up.

Development of metastatic poorly differentiated thyroid cancer from a sub-centimeter papillary thyroid carcinoma in a young patient with a germline MET mutation \u2013 association or random chance?

BackgroundThyroid cancer dedifferentiation is an unusual observation among young patients and is poorly understood, although a recent correlation to DICER1 gene mutations has been proposed.Case presentationA 28-year old patient presented with a sub-centimeter cytology-verified primary papillary thyroid carcinoma (PTC) and a synchronous lateral lymph node metastasis. Following surgery, histopathology confirmed a 9 mm oxyphilic PTC and a synchronous metastasis of poorly differentiated thyroid carcinoma (PDTC). Extensive molecular examinations of both lesions revealed wildtype DICER1 sequences, but identified a somatic ETV6-NTRK3 gene fusion and a MET germline variant (c.1076G > A, p.Arg359Gln). MET is an established oncogene known to be overexpressed in thyroid cancer, and this specific alteration was not reported as a single nucleotide polymorphism (SNP), suggestive of a mutation. Both the primary PTC and the metastatic PDTC displayed strong MET immunoreactivity. A validation cohort of 50 PTCs from young patients were analyzed using quantitative real-time PCR, revealing significantly higher MET gene expression in tumors than normal thyroid controls, a finding which was particularly pronounced in BRAF V600E mutated cases. No additional tumors apart from the index case harbored the p.Arg359Gln MET mutation. Transfecting PTC cell lines MDA-T32 and MDA-T41 with a p.Arg359Gln MET plasmid construct revealed no obvious effects on cellular migratory or invasive properties, whereas overexpression of wildtype MET stimulated invasion.ConclusionsThe question of whether the observed MET mutation in any way influenced the dedifferentiation of a primary PTC into a PDTC metastasis remains to be established. Moreover, our data corroborate earlier studies, indicating that MET is aberrantly expressed in PTC and may influence the invasive behavior of these tumors.

An Mri-Based Machine-Learning Radiomics Approach for Preoperative Evaluation of Lymph Node Metastasis in Hilar Cholangiocarcinoma

Background: Synchronous lymph node metastasis (LNM) affects therapeutic regimes and prognosis for hilar cholangiocarcinoma (hCCA), which is evaluated by conventional imaging examinations with a high false-negative rate. Thus, a preoperative tool capable of predicting LNM status is urgently needed. The aim of this study was to develop an MRI-based radiomics-clinicopathologic approach for preoperative evaluation of LNM status in hCCA. Methods: 325 hCCA patients were enrolled to validate the prognostic effect of LNM on hCCA patients, and 134 cases who underwent preoperative MRI scans, primary surgery and lymph nodes dissection with pathological examination were enrolled to develop the radiomics-clinicopathologic models. The radiomics features were extracted using 3D Slicer software and reproducible features were used to construct radiomics signatures with several typical machine-leraning approaches. Its clinical applicability was compared with already established models for CCA, and its role in prognosis risk stratification was further investigated. Findings: The prognostic impact of LNM was validated in the Sun Yat-sen Memorial Hospital (SUSYM) cohort (hazard ratio [HR], 1.79 (1.36-2.34)). The optimal radiomics signature was based on an elastic network approach, distinguishing LNM status with parallel AUCs of 0.888 and 0.885 in the training and validation cohort, respectively. The radiomics-clinicopathologic model integrated the radiomics signature, carbohydrate antigen 199 level and MRI-reported LNM status, demonstrating better discriminating ability with AUC of 0.905, accuracy of 85.1%, sensitivity of 83.3%, and specificity of 88.0% in the entire cohort. Furthermore, the radiomics-clinicopathologic model could stratify patients into subgroups with different risks for overall survival (hazard ratio [HR], 2.29 (1.41-3.74)). The decision curve analysis showed that our radiomics-clinicopathologic nomogram held better clinical usefulness than clinicopathologic or radiomics signature alone, and excelled those established models for other cholangiocarcinoma. Interpretation: The generated model was promising in non-invasive LNM evaluation and personalized therapeutic strategy decision-making. Funding: This study was supported by grants from China Postdoctoral Science Foundation (2021M693629), the National Natural Science Foundation of China (81972255, 81672412 and 81772597), the Guangdong Basic and Applied Basic Research Foundation (2021A1515010095). Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: Ethical approval was obtained from the institutional review board of Sun Yat-sen Memorial Hospital (SYSMH) of Sun Yat-sen University.

CT Radiomics for the Prediction of Synchronous Distant Metastasis in Clear Cell Renal Cell Carcinoma.

The aim of this study was to construct and verify a computed tomography (CT) radiomics model for preoperative prediction of synchronous distant metastasis (SDM) in clear cell renal cell carcinoma (ccRCC) patients. Overall, 172 patients with ccRCC were enrolled in the present research. Contrast-enhanced CT images were manually sketched, and 2994 quantitative radiomic features were extracted. The radiomic features were then normalized and subjected to hypothesis testing. Least absolute shrinkage and selection operator (LASSO) was applied to dimension reduction, feature selection, and model construction. The performance of the predictive model was validated through analysis of the receiver operating characteristic curve. Multivariate and subgroup analyses were performed to verify the radiomic score as an independent predictor of SDM. The patients randomized into a training (n = 104) and a validation (n = 68) cohort in a 6:4 ratio. Through dimension reduction using LASSO regression, 9 radiomic features were used for the construction of the SDM prediction model. The model yielded moderate performance in both the training (area under the curve, 0.89; 95% confidence interval, 0.81-0.97) and the validation cohort (area under the curve, 0.83; 95% confidence interval, 0.69-0.95). Multivariate analysis showed that the CT radiomic signature was an independent risk factor for clinical parameters of ccRCC. Subgroup analysis revealed a significant connection between the SDM and radiomic signature, except for the lower pole of the kidney subgroup. The CT-based radiomics model could be used as a noninvasive, personalized approach for SDM prediction in patients with ccRCC.

PD-0841 Definitive therapy for anal cancer with synchronous metastases

PD-0841 Definitive therapy for anal cancer with synchronous metastases

Comparison of long-term outcomes of colonic stenting as a "bridge to surgery" and emergency surgery in patients with left-sided malignant colonic obstruction.

Long-term oncologic outcomes of colonic stenting as a "bridge to surgery" in patients with left-sided malignant colonic obstruction (LMCO) are unclear. This study was performed to compare long-term outcomes of self-expandable metal stent (SEMS) insertion as a bridge to surgery and emergency surgery in patients with acute LMCO. This retrospective cohort study included patients with acute LMCO who underwent SEMS insertion as a bridge to surgery or emergency surgery. The primary outcomes were 5-year disease-free survival (DFS), overall survival (OS), and recurrence rate. Survival outcomes were determined using the Kaplan-Meier method and compared using log-rank tests. There was a trend of worsening 5-year OS rate in the SEMS group compared with emergency surgery group (45% vs. 57%, P=0.07). In stage-wise subgroup analyses, a trend of deteriorating 5-year OS rate in the SEMS group with stage III (43% vs. 59%, P=0.06) was observed. The 5-year DFS and recurrence rate were not different between groups. The overall median follow-up time was 58 months. On multivariate analysis, age of ≥65 years and American Joint Committee on Cancer stage of ≥III, and synchronous metastasis were significant poor prognostic factors for OS (hazard ratio [HR], 1.709; 95% confidence interval [CI], 1.007-2.900; P=0.05/HR, 1.988; 95% CI, 1.038-3.809; P=0.04/HR, 2.146; 95% CI, 1.191-3.866; P=0.01; respectively). SEMS as a bridge to surgery may have adverse oncologic outcomes. Patients in the SEMS group had a trend of worsening 5-year OS rate without higher recurrence.

Sites of Synchronous Distant Metastases, Prognosis, and Nomogram for Small Cell Lung Cancer Patients with Bone Metastasis: A Large Cohort Retrospective Study.

Background Small cell lung cancer (SCLC) is often associated with metastases at the time of diagnosis, and the bone is one of the most common sites. The primary aim of this study was to investigate the site of synchronous distant metastasis to other organs in SCLC patients with bone metastasis (BM) and develop a robust predictive prognostic model. Methods We retrospectively analyzed the data from patients diagnosed with SCLC with BM in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. A prognostic nomogram was constructed and evaluated by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Then, according to the sites of metastasis and treatment modality, all patients were stratified into several subgroups. The relationship among sites of metastasis, treatment modality, and overall survival was then analyzed. Results A total of 6253 patients were included. Independent prognostic factors for SCLC with BM were age, sex, primary site, radiotherapy, chemotherapy, brain metastasis, liver metastasis, and marital status. Calibration, ROC curves, and DCA indicated the excellent performance of the prognostic nomogram. The liver is the most common organ for extraskeletal metastases, followed by the lung. Patients with only BM had the longest mean survival time (9.30 ± 0.31 months). In the subgroup analysis, chemotherapy was an independent prognostic factor for all subgroups. In contrast, radiotherapy showed a positive effect on the prognosis of patients in all subgroups except those with bone and brain metastases and those with bone, lung, and brain metastases. Conclusions The prognostic nomogram is expected to be an accurate and personalized tool for predicting the prognosis of SCLC patients with BM. Additionally, the determination of the sites of synchronous extraskeletal metastases and the associated prognosis helps in treatment selection.

СОВРЕМЕННОЕ ЛЕЧЕНИЕ НЕМЕЛКОКЛЕТОЧНОГО РАКА ЛЁГКОГО С ВНУТРИМОЗГОВЫМИ МЕТАСТАЗАМИ И МЕТАСТАТИЧЕСКИМ ПОРАЖЕНИЕМ ПЕЧЕНИ, ЛИМФАТИЧЕСКИХ УЗЛОВ СРЕДОСТЕНИЯ, КОСТЕЙ СКЕЛЕТА. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Introduction: The article covers issues related to modern methods of treatment of non-small cell lung cancer (NSCLC) with multiple synchronous metastases in brain, liver, mediastinal lymph nodes, skeletal bones and describes a clinical case of modern effective treatment and long-term follow-up of a patient with advanced NSCLC and extra- and intracranial metastatic spread.&#x0D; Purpose: Evaluation of modern methods of special antitumor treatment and their application in clinical practice for the treatment of metastatic NSCLC.&#x0D; Material and methods: Modern methods of proton and photon radiation therapy, targeted therapy are considered.&#x0D; Results: The use of modern methods of special antitumor therapy has increased the overall and relapse-free survival rate of patients with multiple metastases of NSCLC in brain, liver, mediastinal lymph nodes, skeletal bones reducing the need for additional interventions. This is confirmed by a long-term follow-up after modern effective antitumor treatment of a patient with advanced NSCLC and synchronous progression in the form of extra- and intracranial metastatic spread. The patient has been alive for more than 2 years from the moment of progression with an estimated life expectancy of 4–5 months.&#x0D; Conclusion: Modern methods of special antitumor therapy can increase the survival rate of patients with multiple synchronous NSCLC metastases in brain, liver, mediastinal lymph nodes, skeletal bones without significant deterioration in their quality of life.

Effect of lymphadenectomy in colorectal cancer with isolated synchronous para-aortic lymph node metastasis.

There is controversy about the treatment of para-aortic lymph node (PALN) metastasis and usefulness of surgical removal. We investigated the clinical effects of synchronous isolated PALN dissection in patients with this metastasis. Patients with colorectal cancer with isolated PALN metastasis were selected between January 2008 and December 2016 at Samsung Medical Center. Patients who were selected for gross-free PALN dissection were set as the dissection group (DG). Patients who did not undergo PALN dissection or underwent biopsy were set as the non-dissection group (NDG). The oncological and operative outcomes were compared. A total of 73 patients were recruited. The most clinical and pathological characteristics were not significantly different. The incidence of postoperative complications was also similar. The 5-year overall survival of DG patients was 33.9%, that of NDG patients was 10.1%, and the survival curves were significantly different (P=0.044). Multivariate analysis revealed that location of tumour in the left colon rather than in the right colon was a risk factor affecting survival in sub-analysis. PALN dissection did not increase postoperative complications and had a better effect on patient survival. It is suggested that lymphadenectomy be performed more aggressively when PALN metastasis is seen in patients with right colon cancer.