Argentiero Antonella, Solimando Antonio Giovanni, Brunetti Oronzo, Calabrese Angela, Pantano Francesco, Iuliani Michele, Santini Daniele, Silvestris Nicola, Vacca Angelo
Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, Viale Orazio Flacco, 65, 70124 Bari, Italy.
Department of Biomedical Sciences and Human Oncology, University of Bari "Ando Moro", Piazza Giulio Cesare, 11, 70124 Bari, Italy.
Cancers (Basel). 2019 Aug 29;11(9):1270. doi: 10.3390/cancers11091270.
Skeletal metastases of unknown primary (SMUP) represent a clinical challenge in dealing with patients diagnosed with bone metastases. Management of these patients has improved significantly in the past few years. however, it is fraught with a lack of evidence. While some patients have achieved impressive gains, a more systematic and tailored treatment is required. Nevertheless, in real-life practice, the outlook at the beginning of treatment for SMUP is decidedly somber. An incomplete translational relevance of pathological and clinical data on the mortality and morbidity rate has had unsatisfactory consequences for SMUP patients and their physicians. We examined several approaches to confront the available evidence; three key points emerged. The characterization of the SMUP biological profile is essential to driving clinical decisions by integrating genetic and molecular profiles into a multi-step diagnostic work-up. Nonetheless, a pragmatic investigation plan and therapy of SMUP cannot follow a single template; it must be adapted to different pathophysiological dynamics and coordinated with efforts of a systematic algorithm and high-quality data derived from statistically powered clinical trials. The discussion in this review points out that greater efforts are required to face the unmet needs present in SMUP patients in oncology.
原发灶不明的骨转移瘤（SMUP）给诊断为骨转移的患者治疗带来了临床挑战。在过去几年中，这些患者的治疗有了显著改善。然而，其治疗缺乏充分证据。虽然一些患者取得了显著疗效，但仍需要更系统、更具针对性的治疗。尽管如此，在实际临床实践中，SMUP患者治疗初期的前景仍不容乐观。病理和临床数据与死亡率及发病率之间不完全的转化相关性，给SMUP患者及其医生带来了不尽人意的后果。我们研究了几种应对现有证据的方法；得出了三个关键点。SMUP生物学特征的表征对于通过将基因和分子特征整合到多步骤诊断检查中来推动临床决策至关重要。尽管如此，SMUP的务实研究计划和治疗不能遵循单一模板；它必须适应不同的病理生理动态，并与系统算法以及来自有统计学效力的临床试验的高质量数据的研究工作相协调。本综述中的讨论指出，在肿瘤学领域，需要付出更大努力来满足SMUP患者尚未满足的需求。
