Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy.
Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", 95122 Catania, Italy.
Medicina (Kaunas). 2021 Sep 9;57(9):950. doi: 10.3390/medicina57090950.
The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10-91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5-39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7-156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.
术语“肢端转移”（AM）是指肘部和膝部远端的继发性病变，占所有骨转移的 0.1%。按频率计算，肺癌和胃肠道及泌尿生殖道肿瘤是导致报道的 AM 的最主要原因。肿瘤患者护理的改善有利于此类罕见病例的发病率增加。我们对手部的肢端转移进行了系统评价，以进一步深入了解这些脆弱患者的治疗方法。我们还介绍了一个同时发生在无名指和病理性椎体骨折的肢端转移的特殊病例。根据 PRISMA（系统评价和荟萃分析的首选报告项目）声明，我们于 2020 年 12 月在 PubMed、Google Scholar 和 Scopus 数据库中，对 1986 年至 2020 年间手部和腕部转移的文献进行了搜索。MeSH 术语包括肢端转移、腕骨转移、手部转移、手指转移、指骨转移和腕部转移。共分析了 215 项报告 247 例患者随访情况的研究，中位年龄为 62 岁（范围 10-91 岁）。247 例患者中，男性 162 例（65.6%），女性 85 例（34.4%）。报告的中位随访时间为 5 个月（范围 0.5-39）。从原发肿瘤诊断到肢端转移的中位时间为 24 个月（范围 0.7-156）。肢端转移位于手指/指骨（68.4%）、腕骨（14.2%）、掌骨（14.2%）或其他部位（3.2%）。91 例（36.8%）患者的原发肿瘤为肺癌。从原发肿瘤诊断到肢端转移的平均间隔时间因原发肿瘤类型而异，从 2 个月（间叶肿瘤患者）到 64.0 个月（乳腺癌患者）不等。肢端转移通常发生在肿瘤疾病的晚期，与预期寿命短有关。它们的发生不再被认为罕见；因此，医生应该了解其手术治疗方法及其对预后和生存的影响。
