Metastatic patterns in adenocarcinoma
Metastatic patterns in adenocarcinoma
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DOI：
10.1002/cncr.21778
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发表时间：
2006-04-01
期刊：
影响因子：
6.2
通讯作者：
Abbruzzese, JL
中科院分区：
文献类型：
--
作者：
Hess, KR;Varadhachary, GR;Abbruzzese, JL
背景。文献中引用的独特转移模式通常来自轶事临床观察和尸检报告。作者分析了大量组织学证实的远期腺癌患者的临床资料，以评估转移模式。1994-1996年间收集了4399例患者的11个原发特纳部位和15个转移部位的肿瘤登记数据。原发和转移部位以各种方式交叉表列以识别模式，作者通过使用多项逻辑回归分析开发算法来预测基于转移模式的原发肿瘤的位置。三个原发肿瘤有单一的显性转移部位：卵巢到腹腔（91%），前列腺到骨骼（90%），胰腺到肝脏（85%）。肝脏是胃肠道（GI）原发肿瘤的主要转移部位（71%），而骨和肺转移在非胃肠道原发肿瘤中最常见（分别为43%和29%）。在一项肝、腹腔、骨联合转移的研究中，86%的前列腺原发肿瘤仅发生骨转移，80%的卵巢原发肿瘤仅发生腹腔转移，74%的胰腺原发肿瘤仅发生肝转移。单一器官是7个部位转移的主要来源：乳房腋窝淋巴结（97%）、结肠肠淋巴结（84%）、肺胸淋巴结（66%）、肺脑淋巴结（64%）、肺纵隔淋巴结（62%）、乳房锁骨上淋巴结（51%）和肺肾上腺（51%）。作者开发的算法在1851名患者独立测试集上实现了64%的交叉验证准确率，而使用随机分类器时的准确率为9%。
BACKGROUND. Unique metastatic patterns cited in the literature often arise from anecdotal clinical observations and autopsy reports. The authors analyzed clinical data from a large number of patients with histologically confirmed, distant-stage adenocarcinoma to evaluate metastatic patterns.METHODS. Tumor registry data were collected between 1994-1996 on 11 primary turner sites and 15 metastatic sites from 4399 patients. The primary and metastatic sites were cross-tabulated in various ways to identify patterns, and the authors developed algorithms by using multinomial logistic regression analysis to predict the locations of primary tumors based on metastatic patterns.RESULTS. Three primary tumors had single, dominant metastatic sites: ovary to abdominal cavity (91%), prostate to bone (90%), and pancreas to liver (85%). The liver was the dominant metastatic site for gastrointestinal (GI) primary tumors (71% of patients), whereas bone and lung metastases were noted most frequently in non-GI primary tumors (43% and 29%, respectively). In a study of combinations of liver, abdominal cavity, and bone metastases, 86% of prostate primary tumors had only bone metastases, 80% of ovarian primary tumors had only abdominal cavity metastases, and 74% of pancreas primary tumors had only liver metastases. A single organ was the dominant source of metastases in 7 sites: axillary lymph node from the breast (97%), intestinal lymph node from the colon (84%), thoracic lymph node from the lung (66%), brain from the lung (64%), mediastinal lymph node from the lung (62%), supraclavicular lymph node from the breast (51%), and adrenal gland from the lung (51%).CONCLUSIONS. The algorithms that the authors developed achieved a cross-validated accuracy of 64% and an accuracy of 64% on an 1851-patient independent test set, compared with 9% accuracy when a random classifier was used.