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小细胞肺癌的胃转移:一个虽罕见但值得关注的实体。

Gastric metastasis of small cell lung carcinoma: A rare but noteworthy entity to consider.

作者信息

Dursun Cemal Ugur, Tugcu Ahmet Oguz, Dogru Galip Dogukan

机构信息

Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul 34865, Türkiye.

Department of Radiation Oncology, Gulhane Training and Research Hospital, Ankara 06010, Türkiye.

出版信息

World J Clin Oncol. 2024 Oct 24;15(10):1379-1382. doi: 10.5306/wjco.v15.i10.1379.

Abstract

Small cell lung carcinoma (SCLC) is an aggressive malignancy known for its propensity for early and extensive metastatic spread. Gastric metastasis, where cancer cells disseminate from the lung to the stomach, is a rare but increasingly recognized complication of SCLC. This review provides a comprehensive overview of gastric metastasis in SCLC, addressing its clinical significance, diagnostic challenges, management strategies, and prognosis. Additionally, it examines the broader metastatic patterns of SCLC and compares them with other malignancies known for gastric metastasis. Gastric metastasis in SCLC, though infrequent, is clinically significant and often indicates advanced disease with a poor prognosis. SCLC typically metastasizes to the liver, brain, bones, and adrenal glands, with the stomach being an unusual site. The incidence of gastric metastasis ranges from 1% to 5% in autopsy studies, although this may be underestimated due to diagnostic difficulties and asymptomatic early lesions. Diagnosing gastric metastasis presents several challenges, including the asymptomatic nature of many cases, limitations of conventional imaging techniques, and difficulties in distinguishing metastatic lesions from primary gastric cancer endoscopy. Histopathological diagnosis requires careful examination to identify SCLC cells through their characteristic small cell morphology and neuroendocrine markers. Management of gastric metastasis in SCLC typically involves a multidisciplinary approach. Systemic therapy, primarily chemotherapy, remains the cornerstone of treatment, with palliative care addressing symptoms and complications. Surgical intervention is usually reserved for specific cases requiring symptomatic relief. The prognosis for patients with gastric metastasis from SCLC is generally poor, reflecting the advanced stage of the disease. Median survival is significantly reduced compared to patients without gastric metastasis. This review emphasizes the need for enhanced awareness and early detection to improve patient outcomes and highlights the importance of ongoing research into better diagnostic and therapeutic strategies.

摘要

小细胞肺癌(SCLC)是一种侵袭性恶性肿瘤,以早期广泛转移扩散的倾向而闻名。胃转移是指癌细胞从肺部扩散到胃部,是小细胞肺癌一种罕见但越来越被认识到的并发症。本综述全面概述了小细胞肺癌中的胃转移,探讨了其临床意义、诊断挑战、管理策略和预后。此外,还研究了小细胞肺癌更广泛的转移模式,并将其与其他已知会发生胃转移的恶性肿瘤进行比较。小细胞肺癌中的胃转移虽然不常见,但具有临床意义,通常表明疾病已处于晚期,预后不良。小细胞肺癌通常转移至肝脏、大脑、骨骼和肾上腺,胃部是一个不常见的转移部位。尸检研究中胃转移的发生率为1%至5%,不过由于诊断困难和早期无症状病变,这一数字可能被低估。诊断胃转移存在诸多挑战,包括许多病例无症状、传统成像技术的局限性以及在内镜检查中难以将转移病变与原发性胃癌区分开来。组织病理学诊断需要仔细检查,通过小细胞特征形态和神经内分泌标志物来识别小细胞肺癌细胞。小细胞肺癌胃转移的管理通常采用多学科方法。全身治疗,主要是化疗,仍然是治疗的基石,姑息治疗则针对症状和并发症。手术干预通常仅适用于需要缓解症状的特定病例。小细胞肺癌胃转移患者的预后通常较差,反映出疾病已处于晚期。与无胃转移的患者相比,中位生存期显著缩短。本综述强调需要提高认识和早期检测以改善患者预后,并突出了持续研究更好的诊断和治疗策略的重要性。

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Metastasis to the stomach: a systematic review.胃转移:系统评价。
F1000Res. 2023 Oct 18;12:1374. doi: 10.12688/f1000research.140758.1. eCollection 2023.
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Mechanisms of small cell lung cancer metastasis.小细胞肺癌转移的机制。
EMBO Mol Med. 2021 Jan 11;13(1):e13122. doi: 10.15252/emmm.202013122. Epub 2020 Dec 9.
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Metastatic Disease in the Stomach.胃转移性疾病
Gastrointest Tumors. 2015 Sep;2(2):61-4. doi: 10.1159/000431304. Epub 2015 Jun 12.
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Gastric metastasis from small cell lung cancer: a case report.小细胞肺癌胃转移:一例报告
World J Gastroenterol. 2015 Feb 7;21(5):1684-8. doi: 10.3748/wjg.v21.i5.1684.
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