McEachron Jennifer, Chatterton Carolyn, Hastings Victoria, Gorelick Constantine, Economos Katherine, Lee Yi-Chun, Kanis Marguax J
Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States.
Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, United States.
Gynecol Oncol Rep. 2020 Feb 10;32:100549. doi: 10.1016/j.gore.2020.100549. eCollection 2020 May.
Metastasis to bone (BM) is an uncommon manifestation of advanced endometrial cancer (EC). The present study will review the clinicopathologic features of a cohort of patients with EC and BM. We conducted a multi-center retrospective review of patients with EC and BM. Demographic and clinical information was extracted from the medical records. Survival outcomes were determined using Kaplan-Meier Curves. Final analysis included 10 patients. The median age was 65 years (range 31-71). 80% had FIGO stage III/IV disease. The most common site of BM was the spine (66%). All patients presented with extraosseous dissemination at the time of diagnosis of BM and 70% were found to have multiple sites of BM. 80% of patients were diagnosed with BM in the recurrent setting. The median time to diagnosis of bone recurrence was 14 months (range: 0-44). Median survival after diagnosis of BM was 11 months (range: 1-22 months). Patients with endometrioid histology and single site of bone metastasis experienced improved survival (p = 0.04 and p = 0.05, respectively). Eight patients had immunohistochemistry or molecular tumor profiles available for review. Seven of these patients (87.5%) were found to have microsatellite instability (MSI). The most common mutation was hypermethylation of MLH-1 (43%). To our knowledge, this is the first report demonstrating a correlation between MSI and metastasis to bone. The identification of BM in EC is uncommon, but will alter treatment strategies and dramatically impact prognosis. Molecular tumor profiling should be performed to identify targeted therapy options and optimize adjuvant treatment strategies.
骨转移（BM）是晚期子宫内膜癌（EC）的一种罕见表现。本研究将回顾一组患有EC和BM患者的临床病理特征。我们对患有EC和BM的患者进行了多中心回顾性研究。从医疗记录中提取了人口统计学和临床信息。使用Kaplan-Meier曲线确定生存结果。最终分析纳入了10名患者。中位年龄为65岁（范围31 - 71岁）。80%的患者为国际妇产科联盟（FIGO）III/IV期疾病。BM最常见的部位是脊柱（66%）。所有患者在诊断BM时均伴有骨外播散，70%的患者发现有多个BM部位。80%的患者在复发时被诊断为BM。诊断骨转移的中位时间为14个月（范围：0 - 44个月）。诊断BM后的中位生存期为11个月（范围：1 - 22个月）。具有子宫内膜样组织学和单部位骨转移的患者生存期有所改善（分别为p = 0.04和p = 0.05）。8名患者有免疫组织化学或分子肿瘤谱可供评估。其中7名患者（87.5%）被发现存在微卫星不稳定性（MSI）。最常见的突变是MLH - 1的高甲基化（43%）。据我们所知，这是第一份证明MSI与骨转移之间存在相关性的报告。EC中BM的识别并不常见，但会改变治疗策略并显著影响预后。应进行分子肿瘤谱分析以确定靶向治疗方案并优化辅助治疗策略。
