Suchergebnisse

Jian Yang,1,* Jijie Yan,2,* Meihui Zeng,3,* Wei Wan,1 Tielong Liu,1 Jian-Ru Xiao1 1Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; 2Ningbo University, Ningbo, Zhejiang, People's Republic of China; 3Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China*These authors contributed equally to this workCorrespondence: Tielong Liu; Jian-Ru Xiao Tel +8602181885634Fax +8602163720099Email hahameixinmeifei@163.com; jianruxiao82@163.comBackground: With the occurrence and improvement of immunohistochemistry and other pathological diagnostic techniques, gastrointestinal stromal tumor (GIST) has been gradually recognized. With the prolonged survival of patients with GISTs, reports about the bone metastasis of GIST increased. However, the knowledge of GISTs is rather limited due to its very low incidence.Methods: Cochrane and Medline database (via PubMed) were searched in July 2019 with related keywords to acquire the literature related to the bone metastasis of GIST. Then, the literature was reviewed and references were also scanned to identify the possible related reports. Study data comprising age, sex, primary location, metastasis interval time, immunohistochemistry index, management and prognosis were recorded and analyzed.Results: Forty-five patients with bone metastases of GIST, with a mean age of 61.09 years, were included. The small intestine and stomach were the most common primary sites, followed by the rectum. Patients with small intestine primary sites had bone metastases that occurred earlier than the bone metastases stomach and rectum primary sites. The spine was the most common site of bony metastases. The mean survival time after GIST diagnosis was more than 64.02 months. Patients younger than 60 years old had a worse prognosis than those older than 60 years old. Furthermore, patients with spinal involvement had a worse prognosis than those without spinal involvement. Surgical interventions combined with targeted therapies guaranteed a better prognosis.Conclusion: Bone metastasis of GIST, which mainly occurs in the spine, is rather rare. Patients with GISTs of the small intestine and stomach suffered from bone metastasis more frequently and earlier than patients with GISTs in other primary sites. Age, sex, primary tumor location, treatment mode for the primary lesions and metastases, and spine involvement may be potential factors that affect the prognosis of GIST patients with bone metastases.Keywords: gastrointestinal stromal tumor, bone metastasis, tyrosine kinase inhibitors, prognosis

Minglei Yang,* Jian Zhao,* Tielong Liu, Xinghai Yang, Haifeng Wei, Wei Xu, Jianru Xiao Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China *These authors contributed equally to this work Background: Previous studies showed that FLT3 inhibitors played an important role in acute myeloid leukemia (AML) therapy. However, discrepancies remain regarding the association between FLT3 inhibitors use and prognosis of AML patients in clinical trials. Aim: The aim of this study was to evaluate the effect of FLT3 inhibitors on the treatment of AML in a systematic review and meta-analysis. Materials and methods: PubMed, Embase, and Cochrane Library databases were searched for studies published before August 2017 that used FLT3 inhibitors in AML. Fixed- and random-effect models were used, and between-study heterogeneity was assessed. Results: A total of 26 studies fitting our inclusion and exclusion criteria were included. The FLT3 status of patients and main treatment outcomes including overall survival (OS), event-free survival (EFS), relapse-free survival (RFS), complete remission (CR), and overall response rate (ORR) after therapy were extracted. Five studies comparing addition of FLT3 inhibitors and placebo or blank control to chemotherapy were analyzed in Part I, showing improved OS (hazard ratio [HR]=0.86, 95% confidence interval [CI]=0.75–0.99, P=0.03) in the FLT3 inhibitor group but without a significant improvement on EFS (HR=0.86, 95% CI=0.62–1.21, P=0.39) and ORR (odds ratio [OR]=1.10, 95% CI=0.89–1.35, P=0.38). Twenty-one studies evaluating the benefit of using FLT3 inhibitors in different FLT3-type AML patients were analyzed in Part II, showing that FLT3–internal tandem duplication (ITD)-positive patients were more sensitive to FLT3 inhibitor treatment and achieved better CR (OR=1.89, 95% CI=1.06–3.37, P=0.03) and ORR (OR=3.07, 95% CI=2.13–4.43, P<0.001). Conclusion: Our study showed that combined use of FLT3 inhibitors improved OS and that the FLT3 status of AML patients could affect their sensitivity to FLT3 inhibitors in terms of CR and ORR. Keywords: acute myeloid leukemia, FLT3–ITD, clinical outcome, meta-analysis

Tao Wang,1,* Xin Gao,1,* Kun Zhang,1,* Jian Yang,1,* Zheyu Wu,1,2 Tielong Liu,1 Qi Jia,1 Jianru Xiao1 1Department of Orthopaedic Oncology, Spinal Tumor Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China; 2Department of Orthopaedics, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, People's Republic of China*These authors contributed equally to this workCorrespondence: Jianru Xiao; Qi Jia Tel +86-021-81886999Email xiaojianru1908@163.com; 15821055604@163.comPurpose: Spinal metastasis from urothelial carcinoma (UC) is relatively uncommon. The aim of the present study is to explore the clinicopathological features, surgical treatments and outcomes of this rare disease.Patients and Methods: Fifteen patients with UC spinal metastasis who received surgery in our center between 2009 and 2018 were retrospectively investigated. Clinical data, treatment options, and outcomes were analyzed.Results: For the 15 patients (9 men and 6 women), the primary tumors were located in the upper urothelial tract in ten and lower urothelial tract in five. UC mainly metastasized to the lumbar spine in seven cases, followed by the thoracic spine in five. Pathologic fracture and soft tissue mass with dura mater compression were observed in 66.7% and 93.3% cases, respectively. Palliative resection was performed in nine cases and excisional resection in six. Eleven patients received postoperative chemotherapy, including three with a preoperative ECOG score > 2. Bisphosphonates were administered in all patients. Pain was relieved remarkably in all patients, and both the neurological function and general status were improved significantly after surgery. The median overall survival was 14 months. Log rank test showed that patients receiving postoperative chemotherapy survived longer than those without chemotherapy (p=0.037). WHO grade 3 was also correlated with poorer prognosis (p=0.012).Conclusion: Pathological fracture and soft tissue mass with dura mater compression is frequently observed on radiological images in patients with UC spinal metastasis. Surgery is useful to prevent deterioration of performance status and improve quality of life, which provide an opportunity for further systematic therapy. Multimodal treatments, including surgery, postoperative chemotherapy and bisphosphonates are recommended. WHO grade 2 and receiving postoperative chemotherapy were favorable prognostic factors for the overall survival of patients with UC spinal metastasis.Keywords: urothelial carcinoma, upper tract urothelial carcinoma, spine metastasis, bisphosphonates, prognosis, WHO grade

Xin Gao,1,* Kun Zhang,1,* Shuang Cao,1,2,* Shuming Hou,1,* Tao Wang,1 Wen Guo,1,3 Zheyu Wu,1,4 Qi Jia,1 Tielong Liu,1 Jianru Xiao1 1Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; 2Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China; 3Department of Orthopedics, Taizhou People's Hospital, Taizhou, Jiangsu Province, People's Republic of China; 4Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China*These authors contributed equally to this workCorrespondence: Tielong Liu; Jianru XiaoOrthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, People's Republic of ChinaTel +0086-021-81886843Fax +0086-021-63520020Email liutielongvip@163.com; xiaojianruvip@163.comPurpose: Metastatic spinal cord compression (SCC) secondary to small cell lung cancer (SCLC) is a disastrous oncological emergency, but it is poorly understood due to the small numbers of patients and their short survival times. Whether patients suffered from SCC caused by metastatic SCLC benefit from spinal surgery remains unknown. The aim of this study was to evaluate the role of surgical treatment and prognostic factors in patients with SCC caused by metastatic SCLC.Methods: From 2009 to 2019, 30 consecutive patients surgically treated for metastatic SCC from SCLC were enrolled in this retrospective analysis. Kaplan–Meier method and Cox regression analysis were used to estimate overall survival (OS) and identify prognostic factors. Quality of life (QoL) was assessed by the three-level EuroQol-five-Dimensions (EQ-5D-3L) instrument and compared using Student's t test.Results: The median OS time was 9 months in our series. Relief of pain, preservation of neurological function, and improvement of performance status were achieved after surgical intervention. The mean EQ-5D-3L utility score showed a significant improvement after surgery (0.3394 preoperatively vs 0.5884 postoperatively). According to Cox regression analysis, postoperative ECOG-PS and immunotherapy were identified to be independent prognostic factors for patients with SCC caused by metastatic SCLC.Conclusion: Despite the short life expectancy, prompt surgical decompression is extremely necessary for patients with SCC caused by SCLC, for surgery played a critical role in improving patients' QoL. Better performance status after surgery and receiving immunotherapy were associated with a longer OS.Keywords: small cell lung cancer, spinal cord compression, surgery, quality of life, prognostic factor, immunotherapy

Shuang Cao,1,2,* Xin Gao,1,* Guangjian Bai,1,* Baoquan Xin,1,* Tao Wang,1 Jiashi Cao,1 Kai Lv,1 Chengzhang Zhu,1 Xiangzhi Ni,1 Weiwei Zou,3 Yejin Zhou,2 Jianru Xiao,1 Tielong Liu1 1Orthopedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; 2Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China; 3Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China*These authors contributed equally to this workCorrespondence: Tielong Liu; Jianru XiaoOrthopedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, People's Republic of ChinaTel +86-21-81886843Fax +86-21-63520020Email liutielongvip@163.com; xiaojianruvvip@163.comPurpose: Spinal tuberculosis (TB) and metastatic tumor (MT) are common diseases with similar manifestations. Although pathological evaluation is the gold standard to confirm diagnosis, performing biopsies in all patients is not feasible. This study is aimed to create a scoring system to facilitate the differential diagnosis of spinal TB and MT before invasive procedures.Methods: Altogether, 447 patients with spinal TB (n=198) and MT (n=249) were retrospectively analyzed. Patients were randomly assigned at 2:1 ratio to a training cohort and a validation cohort. Clinical, laboratory, and radiological diagnostic factors were identified by χ2 and multiple logistic regression analyses. The scoring system was then established based on the identified independent diagnostic factors scored by regression coefficient β value, with the cut-off value being determined by ROC curve. The sensitivity and specificity of the system was calculated by comparing the predicted diagnosis with their actual pathological diagnosis.Results: This scoring system was composed of 5 items: pain worsens at night (0 or 2 points), CRP value (0 or 3 points), tumor marker values (0 or 2 points), skip lesions (0 or 3 points), and intervertebral space destruction (0 or 3 points). Patients scoring higher than 7.5 could be diagnosed as spinal TB, otherwise, MT. According to the internal validation, the sensitivity and specificity of the system were 87.9% and 91.6%, respectively.Conclusion: This study established and validated a scoring system which could be used to differentiate spinal TB from MT, thus helping clinicians in quick and accurate differential diagnosis.Keywords: scoring system, differential diagnosis, spine, tuberculosis, metastatic tumor