Ibrahim Toni, Farolfi Alberto, Mercatali Laura, Ricci Marianna, Amadori Dino
Osteoncology and Rare Tumors Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy.
Tumori. 2013 Jan-Feb;99(1):1-9. doi: 10.1177/030089161309900101.
Advances in the diagnosis and treatment of tumors by surgery, chemotherapy, biotherapy, radiotherapy and other modalities have increased the survival of cancer patients over the last 20 years. As a consequence, bone now represents the third most common site of metastatic involvement after the lung and liver. Approximately 20-25% of patients with neoplastic disease develop clinically evident bone metastases (BMs) during the natural course of their illness, with a further 50% of such lesions being identified during autopsy. BMs are the major cause of morbidity in cancer patients because of their epidemiological and clinical impact. Pain is the most frequent symptom in about 75% of patients but other serious complications can also occur, such as pathological fractures, spinal cord compression, hypercalcemia and bone marrow suppression. These complications worsen the patient's general condition and reduce patients' mobility, facilitating the development of lung infections, skin ulcers, deep vein thrombosis, etc., and ultimately reducing prognosis and quality of life. The frequency of serious complications depends on the site and type of lesions and the treatment administered. Over the last 10 years, the introduction of bisphosphonates for the treatment of patients with BMs has led to a marked decrease in the frequency of complications, thus improving quality of life and clinical outcome. Furthermore, progress in understanding the pathophysiology of bone metastases has resulted in the development of new bone-targeted molecules such as denosumab. We therefore felt it would be useful to report on the epidemiological, clinical and economic impact of bone disease in a cancer setting.
在过去20年中，通过手术、化疗、生物疗法、放射疗法及其他方式进行的肿瘤诊断和治疗取得了进展，提高了癌症患者的生存率。因此，目前骨骼成为继肺和肝脏之后第三大最常见的转移受累部位。在肿瘤疾病患者中，约20%-25%在疾病自然进程中会出现临床明显的骨转移（BMs），另有50%的此类病变在尸检时被发现。由于其流行病学和临床影响，BMs是癌症患者发病的主要原因。疼痛是约75%患者中最常见的症状，但也可能发生其他严重并发症，如病理性骨折、脊髓压迫、高钙血症和骨髓抑制。这些并发症会使患者的总体状况恶化，降低患者的活动能力，促进肺部感染、皮肤溃疡、深静脉血栓形成等情况的发生，并最终降低预后和生活质量。严重并发症的发生频率取决于病变的部位和类型以及所给予的治疗。在过去10年中，引入双膦酸盐用于治疗BMs患者已使并发症的发生频率显著降低，从而改善了生活质量和临床结局。此外，在理解骨转移病理生理学方面的进展导致了如地诺单抗等新的骨靶向分子的开发。因此，我们认为报告癌症背景下骨病的流行病学、临床和经济影响将是有益的。
