Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Department of Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
J Surg Oncol. 2023 Dec;128(8):1446-1452. doi: 10.1002/jso.27433. Epub 2023 Aug 31.
Distinguishing sarcomatoid carcinoma from primary sarcoma is clinically important. We sought to characterize metastatic sarcomatoid bone disease and its management.
We analyzed the characteristics of all cases of sarcomatoid carcinoma to bone at a single institution from 2001 to 2021, excluding patients with nonosseous metastases. Survival was evaluated using the Kaplan-Meier method.
We identified 15 cases of metastatic sarcomatoid carcinoma to bone. In seven cases the primary cancer was unknown at presentation. Renal cell carcinoma was suspected or confirmed in nine cases. Nine patients presented with pathologic fracture and two with concomitant visceral metastases. All patients underwent image-guided core needle or open biopsy. Ten required surgery for discrete osseous metastases; in four cases definitive surgery was delayed (median delay, 19 days) due to inability to rule out sarcoma with frozen section. No patients required reoperation or had construct failure. Thirteen died of disease; median survival was 17.5 months (interquartile range, 6.2-25.1).
Metastatic sarcomatoid carcinoma is a clinically challenging entity. Multidisciplinary input and communication are key to identifying the primary carcinoma, locating osseous metastases, and defining an operative fixation that will survive the remainder of the patient's life.
鉴别肉瘤样癌与原发性肉瘤在临床上很重要。我们旨在分析转移性肉瘤样骨病及其治疗方法。
我们分析了 2001 年至 2021 年在单一机构中所有发生于骨的肉瘤样癌病例（不包括非骨转移患者）的特征。采用 Kaplan-Meier 法评估生存情况。
我们共确定了 15 例转移性肉瘤样癌骨转移患者。7 例患者初诊时原发灶不明。9 例怀疑或确诊为肾细胞癌。9 例患者因病理性骨折就诊，2 例患者伴有同时性内脏转移。所有患者均接受了影像学引导下的核心针或开放活检。10 例患者因离散性骨转移需要手术治疗；4 例患者由于无法通过冷冻切片排除肉瘤而延迟了确定性手术（中位延迟时间为 19 天）。无患者需要再次手术或出现结构失败。13 例患者死于疾病，中位生存期为 17.5 个月（四分位间距，6.2-25.1）。
转移性肉瘤样癌是一种具有挑战性的临床实体。多学科的投入和沟通对于识别原发性癌、定位骨转移灶以及确定能维持患者剩余生存期的手术固定方式至关重要。
