Skeletal Metastasis of Unknown Primary Origin at the Initial Visit: A Retrospective Analysis of 286 Cases

Takagi, Tatsuya; Katagiri, Hirohisa; Kim, Yongji; Suehara, Yoshiyuki; Kubota, Daisuke; Akaike, Keisuke; Ishii, Midori; Mukaihara, Kenta; Okubo, Taketo; Murata, Hideki; Takahashi, Mitsuru; Saito, Tsuyoshi

doi:10.1371/journal.pone.0129428

Cited by 60 publications

(57 citation statements)

References 22 publications

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“…Bone is a common target of distant metastases in prostate cancer (Huang et al, 2015;Mai et al, 2015). The incidence of bone metastases in the process of prostate cancer development is about 65-70%, while it is found in 85-100% in patients who have died from prostate cancer (Jadaan et al, 2015;Takagi et al, 2015). Due to lack of symptoms in the onset of prostate cancer or early bone metastasis, most patients see their physician only once bone metastases have formed and produce symptoms.…”

Section: Introductionmentioning

confidence: 99%

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Wei¹,

Li²,

Yang³

et al. 2016

Genet. Mol. Res.

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ABSTRACT. Bone metastasis is a common complication in prostate cancer patients that can cause bone pain and pathological fracture. This study tested serum levels of prostate specific antigen (PSA), alkaline phosphatase (ALP), bone sialoprotein (BSP), collagen type I pyridine crosslinking peptide (ICTP) in prostate cancer patients and the significance of the receiver operator characteristic (ROC) curve in the diagnosis of prostate cancer bone metastases. Eighty-three prostate cancer patients were enrolled including 42 in the bone metastases group and 41 in the non-bone metastases group. Serum levels of BSP, ALP, ICTP, and PSA were highest in the bone metastases group followed by the non-bone metastases group, hyperplasia group, and then the control group (P < 0.05). Based on Gleason score, serum levels were highest in the poorly differentiated group followed by moderately differentiated and well-differentiated groups (P < 0.05). ROC curve analysis revealed that the diagnostic efficiency of the biomarkers in turn was BSP, PSA, ICTP, and ALP. The sensitivity of BSP, ALP, ICTP, and PSA in the diagnosis of prostate cancer bone metastases were 80.95, 57.14, 69.05, 71.43%, respectively, and the specificity of the same markers were 72. 80, 64.80, 76.80, and 88.80%, respectively. Combined detection of the four markers improved sensitivity to 97.62% and the negativepredictive value increased to 97.60%. PSA + BSP showed the best efficiency when combining two markers. In conclusion, serum levels of BSP, ALP, ICTP, and PSA increased in patients with bone metastases, and combined detection of all markers could improve the positivepredictive value.

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Section: Introductionmentioning

confidence: 99%

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Wei¹,

Li²,

Yang³

et al. 2016

Genet. Mol. Res.

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“…2009, Takagi et al. 2015), we found that specific tumor markers, chest and abdominal CT, and bone biopsy were useful in order to find the primary tumor. All our patients with myeloma had a positive M protein result in serum or urine electrophoresis, and the PSA levels were elevated in all of our patients with prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

Metastatic spinal cord compression as the first sign of malignancy

et al. 2017

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Background and purposeMetastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM.Patients and methodsRecords of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67).ResultsThe primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively.InterpretationPostoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.

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“…9 A recent protocol with a change from technetium bone scan to a PET scan, and an increased panel of tumor marker laboratories, improved the rate of primary tumor identification to 88.8%. 11 When there is a known history of recent metastatic cancer, immediate needle biopsy may be used to confirm the origin of metastatic disease. This has a high likelihood of diagnosing the lesion with a reported success rate of 98.4%.…”

Section: Biopsymentioning

confidence: 99%

Management of Pathologic Fractures Around the Hip: Part 1–Femur

et al. 2019

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Evaluation and management of suspected pathologic fractures, secondary to metastatic disease, require a comprehensive understanding of the underlying disease process and a multidisciplinary treatment approach. Recognition of a pathologic fracture can be challenging, and the diagnosis today remains often missed, but is necessary for appropriate care. The incidence of cancer in the United States is on the rise, and with advances in medical and surgical care the prevalence of cancer is increasing as well. This will result in a similar trend of increased incidence and prevalence of metastatic disease requiring treatment from orthopaedic surgeons. The proximal femur is the most common location for metastatic lesions in the appendicular skeleton, and as such sees a disproportionate number of pathologic fractures. This site of injury is particularly challenging to manage due to the transmission of high forces through this region during ambulation. A combination of adjunct therapies and surgical intervention will maximize the outcomes for these patients. Obtaining a tissue diagnosis, especially in the setting of a solitary bone lesion, is a crucial and required early step in this process.

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Skeletal Metastasis of Unknown Primary Origin at the Initial Visit: A Retrospective Analysis of 286 Cases

Cited by 60 publications

References 22 publications

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Serum levels of PSA, ALP, ICTP, and BSP in prostate cancer patients and the significance of ROC curve in the diagnosis of prostate cancer bone metastases

Metastatic spinal cord compression as the first sign of malignancy

Management of Pathologic Fractures Around the Hip: Part 1–Femur

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