Katagiri H, Takahashi M, Inagaki J, Sugiura H, Ito S, Iwata H
Department of Orthopedic Surgery, Nagoya University School of Medicine, Japan.
Cancer. 1999 Aug 1;86(3):533-7. doi: 10.1002/(sici)1097-0142(19990801)86:3<533::aid-cncr24>3.0.co;2-1.
When skeletal metastasis is the presenting problem and the primary site is occult, there is a need to identify the primary site as soon as possible. However, the search for the primary tumor is often time-consuming and difficult. The purpose of this study was to analyze the efficacy of particular diagnostic approaches and to devise an efficient and optimal diagnostic strategy.
Among 213 patients with skeletal metastasis treated between 1990 and 1996 were 64 in whom skeletal lesions were the first manifestation of malignancy. The authors retrospectively analyzed both the final diagnosis and the process by which it was made in these 64 cases.
The primary cancer was identified antemortem in 56 (88%) of the 64 patients by examination and in 3 patients at autopsy. Lung carcinoma, the most frequently observed primary lesion, was identified in 23 patients. Other primary lesions were prostate carcinoma in 11 patients, breast carcinoma in 5, and hepatocellular carcinoma in 5. The primary malignancy was not determined in 5 patients. Thoracic and abdominal computed tomography (CT) scans were useful, especially in the diagnosis of patients with lung, hepatocellular, renal cell, and pancreatic carcinomas. Tumor markers were abnormally elevated in 73% of patients with carcinomas.
Although thoracic and abdominal CT scans were useful, examination of the gastrointestinal tract and pelvic CT scan seldom revealed the primary lesion and therefore should not be performed as an initial routine study in the absence of abdominal symptoms. Tumor markers are useful in differentiating carcinoma from hematologic malignancy and primary bone tumor.
当以骨转移为首要问题且原发部位隐匿时，需要尽快确定原发部位。然而，寻找原发肿瘤往往耗时且困难。本研究的目的是分析特定诊断方法的疗效，并制定一种高效且最佳的诊断策略。
在1990年至1996年间接受治疗的213例骨转移患者中，有64例患者的骨病变是恶性肿瘤的首发表现。作者回顾性分析了这64例患者的最终诊断及其诊断过程。
64例患者中有56例（88%）在生前通过检查确定了原发癌，3例在尸检时确定。最常观察到的原发病变是肺癌，有23例患者确诊。其他原发病变包括前列腺癌11例、乳腺癌5例、肝细胞癌5例。5例患者未确定原发恶性肿瘤。胸部和腹部计算机断层扫描（CT）很有用，尤其在诊断肺癌、肝细胞癌、肾细胞癌和胰腺癌患者时。73%的癌症患者肿瘤标志物异常升高。
尽管胸部和腹部CT扫描有用，但胃肠道检查和盆腔CT扫描很少能发现原发病变，因此在没有腹部症状时不应作为初始常规检查进行。肿瘤标志物有助于区分癌与血液系统恶性肿瘤及原发性骨肿瘤。
