Trauma Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
ANZ J Surg. 2023 May;93(5):1169-1175. doi: 10.1111/ans.18324. Epub 2023 Feb 11.
Colorectal cancer (CRC) metastasis commonly occurs in the liver and lungs with bone metastasis rarely occurring in isolation. Disseminated carcinomatosis of bone marrow (DCBM) is extremely rare in CRC. We conducted a systematic review to provide more information on the diagnosis, treatment options, and prognosis of the condition.
Studies were identified by performing searches on MEDLINE and EMBASE electronic databases according to the PRISMA statement standards. We included a single patient whom we treated for metastatic CRC presenting with DCBM in our study. Statistical analysis was performed using SPSS software version 23.0.
A search through 5502 unique studies yielded 14 studies that were eventually included. There was a total of 17 cases of DCBM in CRC with back pain and constitutional symptoms as the most common presenting complaints. DCBM in CRC was associated with markedly elevated CEA of 275.57 (95% CI 17.13-534.00). There was no predilection for site of primary tumour. Overall median survival was 120 days (95% CI 64.43-175.58). The median survival for patients who received chemotherapy was 240 days (95% CI 71.11-408.89), as compared to 9 days (95% CI 1.80-16.20) for patients who received best supportive treatment.
DCBM from CRC is extremely rare. Bone marrow examination remains the gold standard for diagnosis. Colonic stenting or surgical diversion may be more appropriate than primary resection in obstructed CRC in view of the poor prognosis. Systemic chemotherapy shows promise in increasing median survival.
结直肠癌（CRC）转移通常发生在肝脏和肺部，而孤立性骨转移则很少见。骨髓播散性癌病（DCBM）在 CRC 中极为罕见。我们进行了系统评价，以提供有关该疾病的诊断、治疗选择和预后的更多信息。
根据 PRISMA 声明标准，通过在 MEDLINE 和 EMBASE 电子数据库中进行搜索来确定研究。我们在研究中纳入了一名患有转移性 CRC 并伴有 DCBM 的单一患者。使用 SPSS 软件版本 23.0 进行统计分析。
通过对 5502 项独特研究进行搜索，最终纳入了 14 项研究。共有 17 例 CRC 患者出现 DCBM，背痛和全身症状是最常见的首发症状。CRC 中的 DCBM 与明显升高的 CEA（275.57，95%CI 17.13-534.00）相关。原发肿瘤部位无偏好。总体中位生存期为 120 天（95%CI 64.43-175.58）。接受化疗的患者中位生存期为 240 天（95%CI 71.11-408.89），而接受最佳支持治疗的患者中位生存期为 9 天（95%CI 1.80-16.20）。
CRC 引起的 DCBM 极为罕见。骨髓检查仍然是诊断的金标准。鉴于预后较差，对于梗阻性 CRC，结肠支架置入或手术转流可能比原发切除术更合适。全身化疗有望延长中位生存期。
