The current research status and treatment of bone metastasis from colorectal cancer

doi:10.3877/cma.j.issn.2095-3224.2020.06.012

Abstract

Abstract:

Colorectal cancer is one of most common malignant tumors in China. Bone metastasis (BM) from colorectal cancer is rare in clinic, which is usually accompanied with distant metastases of other sites. However, its incidence has gradually increased in recent years. Most of colorectal cancer patients with BM have a poor prognosis due to the advanced stage and skeletal-related events (SREs) such as severe bone pain. The most common site of BM from colorectal cancer is spine, followed by pelvis and its diagnosis mainly depends on imaging examination. A number of studies have been carried out at home and abroad to explore the risk factors and prognostic factors of BM from CRC. Although there are no standardized clinical guidelines, more knowledge on the treatment strategies for bone metastasis has been acquired with the development of medical science. This paper summarized the domestic and foreign literature to introduce the current research status and treatment of BM from CRC.

Key words: Colorectal neoplasms, Bone metastasis, Epidemiology, Diagnosis, Treatment

Chenxi Ma, Xu Guan, Xishan Wang. The current research status and treatment of bone metastasis from colorectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(06): 605-609.

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References 51

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影像学方法	优势	劣势
X线	1.特异性高：可诊断骨关节病等骨病，便于排除骨良性病变 2.定性诊断：骨转移瘤在X线片上可表现为溶骨型、成骨型及混合型^[20] 3.经济方便	1.诊断滞后性：骨质破坏30%~50%显示异常^[30] 2.敏感度低：骨转移瘤检出率约60%
CT	1.显示清晰：可明确骨质破坏范围、破坏区有无肿瘤组织形成以及肿瘤对周围组织的侵犯程度等 2.有助于压缩性骨折的定性诊断^[33]	诊断滞后性：反映骨皮质破坏情况较X线敏感，但仍需到一定程度才能显示异常^[30]
⁹⁹Tc^m骨显像	1.早期诊断：骨质破坏达5%显示异常 2.敏感度高：骨转移瘤检出率达94% 3.全身成像：可发现不同部位多发病灶，更准确反映骨转移灶数目	1.特异性差：难以鉴别骨关节病、骨折、骨髓炎和Paget病等伴有双膦酸盐沉积的良性病 2.解剖图像不佳
MRI	1.早期诊断：比CT及骨扫描可更早探测到骨转移病灶^[33] 2.定位诊断准确：可明确骨髓破坏程度、髓腔内原发灶与转移灶、侵犯范围、受累血管情况等^[30] 3.无放射性损伤	难以鉴别血管瘤、炎症性反应等良性病^[30]
¹⁸F-FDG PET/PET-CT	1.早期诊断：可在骨转移侵犯骨髓而未累及骨皮质时发现病灶，优于CT和骨扫描^[30] 2.敏感度高：检测率高于其他影像学方法，可达90%以上^[31,32,34] 3.评估全面：可同时检测原发肿瘤位置、淋巴结状态及远处转移^[35]	1.易受近期放化疗的影响 2.费用较高

影像学方法	优势	劣势
X线	1.特异性高：可诊断骨关节病等骨病，便于排除骨良性病变 2.定性诊断：骨转移瘤在X线片上可表现为溶骨型、成骨型及混合型^[20] 3.经济方便	1.诊断滞后性：骨质破坏30%~50%显示异常^[30] 2.敏感度低：骨转移瘤检出率约60%
CT	1.显示清晰：可明确骨质破坏范围、破坏区有无肿瘤组织形成以及肿瘤对周围组织的侵犯程度等 2.有助于压缩性骨折的定性诊断^[33]	诊断滞后性：反映骨皮质破坏情况较X线敏感，但仍需到一定程度才能显示异常^[30]
⁹⁹Tc^m骨显像	1.早期诊断：骨质破坏达5%显示异常 2.敏感度高：骨转移瘤检出率达94% 3.全身成像：可发现不同部位多发病灶，更准确反映骨转移灶数目	1.特异性差：难以鉴别骨关节病、骨折、骨髓炎和Paget病等伴有双膦酸盐沉积的良性病 2.解剖图像不佳
MRI	1.早期诊断：比CT及骨扫描可更早探测到骨转移病灶^[33] 2.定位诊断准确：可明确骨髓破坏程度、髓腔内原发灶与转移灶、侵犯范围、受累血管情况等^[30] 3.无放射性损伤	难以鉴别血管瘤、炎症性反应等良性病^[30]
¹⁸F-FDG PET/PET-CT	1.早期诊断：可在骨转移侵犯骨髓而未累及骨皮质时发现病灶，优于CT和骨扫描^[30] 2.敏感度高：检测率高于其他影像学方法，可达90%以上^[31,32,34] 3.评估全面：可同时检测原发肿瘤位置、淋巴结状态及远处转移^[35]	1.易受近期放化疗的影响 2.费用较高

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