Colonic and anal metastases from pancreato-biliary malignancies

Pancreato-biliary malignancies often present with locally advanced or metastatic disease.Surgery is the mainstay of treatment although less than 20%of tumours are suitable for resection at presentation.Common sites for metastases are liver,lungs,lymph nodes and peritoneal cavity.Metastatic disease carries poor prognosis,with median survival of less than 3 mo.We report two cases where metastases from pancreato-biliary cancers were identified in the colon and anal canal.In both cases specific immunohistochemical staining was utilised in the diagnosis.In the first case,the pre-senting complaint was obstructive jaundice due to an ampullary tumour for which a pancreato-duodenectomy was carried out.However,the patient re-presented 4wk later with an atypical anal fissure which was found to be metastatic deposit from the primary ampullary adenocarcinoma.In the second case,the patient presented with obstructive jaundice due to a biliary stricture.Subsequent imaging revealed sigmoid thickening,which was confirmed to be a metastatic deposit.Distal colonic and anorectal metastases from pancreatobiliary cancers are rare and can masquerade as primary colorectal tumours.The key to the diagnosis is the specific immunohistochemical profile of the intestinal lesion biopsies.

Multi-organ site metastatic reactivation mediated by non-canonical discoidin domain receptor 1 signaling

With the support of the National Natural Science Foundation of China and the Ministry of Science and Technology of China,the research teams led by Prof.Gao Hua(高华)from Tongji University,and Prof.Filippo Giancotti at Memorial Sloan Kettering Cancer Center,reported recently on the mechanism of multiorgan site metastatic creactivation,which was published in Cell(2016,166:47—62).

Regional location of lymph node metastases predicts survival in patients with de novo metastatic prostate cancer

To report the regional locations of metastases and to estimate the prognostic value of the pattern of regional metastases inmen with metastatic hormone-sensitive prostate cancer (mHSPC), we retrospectively analyzed 870 mHSPC patients betweenNovember 28, 2009, and February 4, 2021, from West China Hospital in Chengdu, China. The patients were initially classifiedinto 5 subgroups according to metastatic patterns as follows: simple bone metastases (G1), concomitant bone and regional lymphnode (LN) metastases (G2), concomitant bone and nonregional LN (NRLN) metastases (G3), lung metastases (G4), and livermetastases (G5). In addition, patients in the G3 group were subclassified as G3a and G3b based on the LN metastatic plane(below or above the diaphragm, respectively). The associations of different metastatic patterns with castration-resistant prostatecancer-free survival (CFS) and overall survival (OS) were analyzed by univariate and multivariate analyses. The results showedthat patients in G1 and G2 had relatively favorable clinical outcomes, patients in G3a and G4 had intermediate prognoses, andpatients in G3b and G5 had the worst survival outcomes. We observed that patients in G3b had outcomes comparable to those inG5 but had a significantly worse prognosis than patients in G3a (median CFS: 8.2 months vs 14.3 months, P = 0.015;medianOS: 38.1 months vs 45.8 months, P = 0.038). In conclusion, metastatic site can predict the prognosis of patients with mHSPC,and the presence of concomitant bone and NRLN metastases is a valuable prognostic factor. Furthermore, our findings indicatethat the farther the NRLNs are located, the more aggressive the disease is.

Organ-specific efficacy in advanced non-small cell lung cancer patients treated with first-line single-agent immune checkpoint inhibitors

Background:Response to immune checkpoint inhibitors(ICIs)is affected by multiple factors.This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer(NSCLC)patients.Methods::The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People’s Hospital between May 2019 and July 2020 were retrospectively analyzed.Metastatic sites included liver,bone,brain,adrenal gland,pleura,and contralateral lung.Progression-free survival(PFS)and overall survival(OS)were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method.Organ-specific disease control rate(OSDCR)of different individual metastatic sites was evaluated.Results:Forty NSCLC patients meeting the criteria were identified.The presence of liver metastasis was significantly associated with shorter PFS(3.1 vs.15.5 months,P=0.0005)and OS(11.1 months vs.not reached,P=0.0016).Besides,patients with bone metastasis tend to get shorter PFS(4.2 vs.15.5 months,P=0.0532)rather than OS(P=0.6086).Moreover,the application of local treatment could numerically prolong PFS in patients with brain metastasis(15.5 vs.4.3 months,P=0.1894).More metastatic organs involved were associated with inferior PFS(P=0.0052)but not OS(P=0.0791).The presence of liver metastasis or bone metastasis was associated with more metastatic organs(Phi[φ]:0.516,P=0.001).The highest OSDCR was observed in lung(15/17),and the lowest in the liver(1/4).Conclusions:Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC.ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis,thus patients with this type of metastasis might require more aggressive combination strategies.

Clinical information and management status of de novo stage IV breast cancer patients: a Chinese multicenter investigation (CSBrS-002)

Background:Although de novo stage IV breast cancer is so far incurable,it has entered an era of individualized treatment and chronic disease management.Based on systemic treatment,whether the surgical resection of primary or metastatic foci of de novo stage IV breast cancer can bring survival benefits is currently controversial.We aimed to explore the clinicopathological factors and current status of the management of de novo stage IV breast cancer in China to provide a reference for clinical decisions.Methods:Based on the assistance of Chinese Society of Breast Surgery,a retrospective study was conducted to analyze the clinical data of patients with de novo stage IV breast cancer in 33 centers from January 2017 to December 2018.The relationship between basic characteristic(age,menstrual status,family history,reproductive history,pathological type,estrogen receptor[ER]status,progesterone receptor[PR]status,human epidermal growth factor receptor 2[HER2]status,Ki-67 percentage,and molecular subtype),and metastasis sites(lung metastasis,liver metastasis,and bone metastasis)was examined by Pearson Chi-square tests.Results:A total of 468 patients with de novo stage IV breast cancer were enrolled.The median age of the enrolled patients was 51.5 years.The most common pathological type of primary lesion was invasive carcinoma(97.1%).Luminal A,luminal B,HER2 overexpressing,and triple-negative subtypes accounted for 14.3%,51.8%,22.1%,and 11.8% of all cases,respectively.Age,PR status,and HER2 status were correlated with lung metastasis(χ^(2)=6.576,4.117,and 8.643 and P=0.037,0.043,and 0.003,respectively).Pathological type,ER status,PR status,and molecular subtype were correlated with bone metastasis(χ^(2)=5.117,37.511,5.224,and 11.603 and P=0.024,<0.001,0.022,and 0.009,respectively).Age,PR status,HER2 status,Ki-67 percentage,and molecular subtype were correlated with liver metastasis(χ^(2)=11.153,13.378,10.692,21.206,and 17.684 and P=0.004,<0.001,0.001,<0.001,and 0.001,respectively).Combined treatment with paclitaxel and anthracycline was the most common first-line chemotherapy regimen for patients with de novo stage IV breast cancer(51.7%).Overall,91.5% of patients used paclitaxel-containing regimens.Moreover,59.3% of hormone receptor-positive patients underwent endocrine therapy.Conclusions:In 2018,1.07% of patients from all studied centers were diagnosed with de novo stage IV breast cancer.This study indicated that 95.1% of patients received systemic therapy and 54.2% of patients underwent surgical removal of the primary lesion in China.