骨科医生最常处理的常见癌种的骨骼肌肉转移。文献系统回顾。

Skeletal muscle metastasis from the most common carcinomas orthopedic surgeons deal with. A systematic review of the literature.

机构信息

Division of Musculoskeletal Oncology, Department of Orthopedics, Miller School of Medicine, University of Miami, 1400 NW 12th Avenue East Building, 4th Floor Suite 4036, Miami, FL, 33136, USA.

PGY-4 Orthopedic Surgery, Department of Orthopaedic Surgery, 12 Octubre University Hospital, Madrid, Spain.

出版信息

Arch Orthop Trauma Surg. 2017 Nov;137(11):1477-1489. doi: 10.1007/s00402-017-2782-z. Epub 2017 Aug 29.

DOI:10.1007/s00402-017-2782-z

PMID:28852837

Abstract

INTRODUCTION

There is scarce information in the literature dealing with the clinical presentation, management and oncologic outcomes of skeletal muscle metastases (SMM). We sought to perform a systematic review of the literature to investigate: (1) tumor characteristics of SMM, (2) therapeutic approach, and (3) oncological outcomes.

METHODS

A systematic review of the literature was performed using PubMed and EMBASE search engines. A total of 3231 references were reviewed and 49 studies were included. Demographic data, presentation characteristics, and oncological outcomes were recorded. Statistical analysis was performed using SPSS 22.0 software (IBM; Armonk, New York) and Comprehensive Meta-Analysis software version 3 (Biostat, Inc.), with p < 0.05 as statistically significant.

RESULTS

A total of 231 patients were included. These tumors presented more commonly on males 58.4% (135/231), with a mean age of 60.08 ± 10.6 years, and in the axial area 39.6% (88/222). The most common carcinoma type was lung 41.1% (95/231). Resection of a single metastases did not change survival significantly (p = 0.992). LRR was higher within the group of patients that underwent WLE compared with non-WLE [31.3% (23/74) vs. 8.7% (2/23), p ≤ 0.001]. Kaplan-Meier survival analysis for the entire cohort showed an estimate of 15.3 months [95% confidence interval (CI) 11.6-19; standard error (SE) 0.432], with lung carcinoma carrying the worst prognosis 6.7 months (95% CI 5.4-8.07; SE 0.68). Patients with a single SMM showed a worse estimate mean survival time compared to patients with multiple metastases limited to muscles [8.6 months (95% CI 4.7-12.5; SE 2.0) vs 25.4 months (95% CI 19.8-31.05; SE 2.8; p ≤ 0.001)].

CONCLUSIONS

Overall survival is poor and is driven mainly by the type of carcinoma. An Increased LRR might be present due to the systemic nature of the condition, and degree of control of the primary carcinoma.

摘要

简介

关于骨骼肌转移瘤（SMM）的临床表现、治疗方法和肿瘤学结局，文献中相关信息匮乏。我们旨在对文献进行系统综述，以调查：（1）SMM 的肿瘤特征，（2）治疗方法，以及（3）肿瘤学结局。

方法

我们使用 PubMed 和 EMBASE 搜索引擎对文献进行了系统综述。共查阅了 3231 篇参考文献，纳入了 49 项研究。记录了人口统计学数据、表现特征和肿瘤学结局。使用 SPSS 22.0 软件（IBM；Armonk，纽约）和 Comprehensive Meta-Analysis 软件版本 3（Biostat，Inc.）进行统计分析，以 p<0.05 为统计学显著差异。

结果

共纳入 231 例患者。这些肿瘤多见于男性 58.4%（135/231），平均年龄 60.08±10.6 岁，且多发生于轴区 39.6%（88/222）。最常见的癌类型是肺癌 41.1%（95/231）。单个转移灶切除对生存率无显著影响（p=0.992）。与非广泛局部切除术（WLE）相比，WLE 组的 LRR 更高[31.3%（23/74）vs. 8.7%（2/23），p≤0.001]。对整个队列的 Kaplan-Meier 生存分析显示，估计 15.3 个月[95%置信区间（CI）11.6-19；标准误差（SE）0.432]，肺癌的预后最差为 6.7 个月[95%CI 5.4-8.07；SE 0.68]。与多发性局限于肌肉的转移瘤相比，单发 SMM 患者的平均生存时间估计更差[8.6 个月（95%CI 4.7-12.5；SE 2.0）vs 25.4 个月（95%CI 19.8-31.05；SE 2.8；p≤0.001)]。