Hawksworth J, Geisinger K, Zagoria R, Kavanagh P, Howerton R, Levine E A, Shen P
Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Am Surg. 2004 Jun;70(6):512-7.
Metastatic adenocarcinoma to the liver from an unknown primary tumor (UPT) carries a poor prognosis, with a median survival of 5 months. Chemotherapy has not significantly improved outcome, and effective treatment is yet to be established in these patients. We examined our experience with surgical resection and ablation of this disease to determine clinico-pathologic characteristics and treatment outcomes. We undertook a retrospective chart review of 157 patients who were treated for metastatic disease to the liver with resection or radiofrequency ablation (RFA) between 1999 and 2003. Seven patients were identified with unknown primary malignancy. Evaluation of the seven patients included complete history and physical examination, complete blood count, routine chemistries, stool Hemoccult test, chest radiograph, and computed tomography (CT) of the abdomen and pelvis. In addition, the three female patients had breast examinations and mammography. Adenocarcinoma histology was determined via CT-guided liver biopsy in all patients. Other diagnostic tests, including whole-body positron emission tomography to the measurement of various serum tumor markers, were performed in the majority of the patients. There were nine total lesions treated; six with RFA and three with hepatic resection. Median diameter of the lesions was 5.4 cm (range, 1.3-15). Two patients were treated with adjuvant and three patients with neoadjuvant and adjuvant chemotherapy. Extrahepatic sites of metastases, adrenal and skeletal, were discovered in 1 patient prior to treatment. With a median follow-up of 9 months, 1 patient is currently alive with no evidence of disease, 4 patients are alive with disease, and 2 patients died of disease. Median disease-free-interval following treatment was 6.5 months. To date, optimal treatment for metastatic adenocarcinoma to the liver UPT remains unclear. Localized treatment involving RFA or hepatic resection may be a promising addition to chemotherapy in the management of this disease.
原发灶不明的肿瘤（UPT）肝转移性腺癌预后较差，中位生存期为5个月。化疗并未显著改善预后，目前仍未确立针对这些患者的有效治疗方法。我们回顾了对该疾病进行手术切除和消融治疗的经验，以确定临床病理特征和治疗效果。我们对1999年至2003年间接受肝转移瘤切除或射频消融（RFA）治疗的157例患者进行了回顾性病历审查。其中7例患者被确定为原发恶性肿瘤不明。对这7例患者的评估包括完整的病史和体格检查、全血细胞计数、常规生化检查、大便潜血试验、胸部X光片以及腹部和盆腔的计算机断层扫描（CT）。此外，3名女性患者接受了乳房检查和乳房X光摄影。所有患者均通过CT引导下肝活检确定腺癌组织学类型。大多数患者还进行了其他诊断检查，包括全身正电子发射断层扫描和各种血清肿瘤标志物检测。共治疗了9个病灶；6个采用RFA治疗，3个采用肝切除治疗。病灶的中位直径为5.4厘米（范围为1.3 - 15厘米）。2例患者接受了辅助化疗，3例患者接受了新辅助化疗和辅助化疗。1例患者在治疗前发现有肝外转移部位，即肾上腺和骨骼转移。中位随访时间为9个月，1例患者目前无疾病证据存活，4例患者带瘤存活，2例患者死于疾病。治疗后的中位无病间期为6.5个月。迄今为止，UPT肝转移性腺癌的最佳治疗方法仍不明确。在该疾病的治疗中，涉及RFA或肝切除的局部治疗可能是化疗的一个有前景的补充。
