Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Int J Cancer. 2021 Sep 15;149(6):1266-1273. doi: 10.1002/ijc.33684. Epub 2021 May 25.
Umbilical metastases form a clinical challenge, especially when they represent the first sign of malignant disease and the primary tumor is unknown. Our study aims to generate insight into the origin and timing of umbilical metastasis, as well as patient survival, using population-based data. A nationwide review of pathology records of patients diagnosed with an umbilical metastasis between 1979 and 2015 was performed. Data was collected from the Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) and the Netherlands Cancer Registry. Kaplan-Meier analyses and log-rank testing were used to estimate overall survival and a Cox proportional hazard model was used to determine multivariable hazard ratios. A total of 806 patients with an umbilical metastasis were included. There were 210 male (26.1%) and 596 female (73.9%) patients. Distribution of umbilical metastases was different between male and female patients due to the high incidence of umbilical metastases originating from the ovaries in females. They most frequently originated from the ovaries in female patients (38.8%) and from the colon in male patients (43.8%). In 18% of cases no primary tumor could be identified. Prognosis after diagnosis of an umbilical metastasis was dismal with a median survival of 7.9 months (95% confidence interval 6.7-9.1). The origin of the primary tumor was an independent prognostic factor for overall survival. In conclusion, umbilical metastases relatively rare, mainly originating from intraabdominal primary tumors. Survival is dependent on the origin of the primary tumor and poor overall survival rates warrant early recognition.
脐部转移形成了临床挑战，尤其是当它们是恶性疾病的首发表现且原发肿瘤未知时。本研究旨在利用基于人群的数据，深入了解脐部转移的起源和时间，以及患者的生存情况。对 1979 年至 2015 年间诊断为脐部转移的患者的病理学记录进行了全国性的回顾性研究。数据来自全国性的组织病理学和细胞学网络及登记处（PALGA）和荷兰癌症登记处。使用 Kaplan-Meier 分析和对数秩检验来估计总生存率，并使用 Cox 比例风险模型来确定多变量风险比。共纳入 806 例脐部转移患者，其中男性 210 例（26.1%），女性 596 例（73.9%）。由于女性中卵巢来源的脐部转移发生率较高，男女患者的脐部转移分布存在差异。女性患者中最常见的原发肿瘤为卵巢（38.8%），而男性患者中最常见的原发肿瘤为结肠（43.8%）。18%的病例无法确定原发肿瘤。诊断为脐部转移后预后较差，中位生存时间为 7.9 个月（95%置信区间 6.7-9.1）。原发肿瘤的来源是总生存率的独立预后因素。总之，脐部转移较为罕见，主要来源于腹腔内的原发肿瘤。生存取决于原发肿瘤的来源，总体生存率较差，需要早期识别。
