Purpose

Pulmonary metastasis was a negative factor of osteosarcoma prognosis. However, there is no universal criteria to confirm pulmonary metastasis at pulmonary micro nodule (PMN, Dmax ≤ 5 mm) stage other than pathology. We aimed to identify prevalence of PMNs, determine prognosis of osteosarcoma with PMNs, and analyze risk factors related to PMN progression.

Methods

We retrospectively reviewed 425 consecutive osteosarcoma patients. According to dynamic change in size and number of PMNs, patients were divided into PMN progression and non-progression group. Demographic data, initial laboratory data, radiological features, and oncological evaluations were analyzed. Cox regression was used to identify risk factors for PMN progression. Overall survival rate was measured and analyzed with Kaplan–Meier method. Differences with p < 0.05 were considered significant.

Results

PMNs were found in 74% (315/425) osteosarcoma patients, half of whom (157/315) suffering PMN progression. Overall survival rate was 70.2%, while survival rates for PMN progression group and non-progression group were 53.40% and 87.40%, respectively. Clinical risk factors for PMN progression in certain patients included blood vessel invasion, extrapulmonary metastases, low tumour cell necrosis rate, and large tumour size. Radiologic risk factors included greatest diameter, distance to pleura, CT value, solid components, and smooth border.

Conclusion

PMN is quite common in osteosarcoma patients. PMN progression is related to both certain clinical and radiological factors, which could assist surgeons to determine its possibility to progress at an early stage.

中文翻译：

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如何应对骨肉瘤患者肺微结节 (PMNs) 的高患病率？

目的

肺转移是影响骨肉瘤预后的不利因素。然而，除病理学外，尚无通用的标准来确认肺微结节（PMN，Dmax ≤ 5 mm）阶段的肺转移。我们的目的是确定 PMN 的患病率，确定 PMN 骨肉瘤的预后，并分析与 PMN 进展相关的危险因素。

方法

我们回顾性分析了 425 名连续的骨肉瘤患者。根据PMN大小和数量的动态变化，将患者分为PMN进展组和非进展组。分析了人口统计学数据、初始实验室数据、放射学特征和肿瘤学评估。Cox 回归用于确定 PMN 进展的危险因素。用Kaplan-Meier方法测量和分析总生存率。p < 0.05的差异 被认为是显着的。

结果

在 74% (315/425) 的骨肉瘤患者中发现了 PMN，其中一半 (157/315) 患有 PMN 进展。总生存率为 70.2%，而 PMN 进展组和非进展组的生存率分别为 53.40% 和 87.40%。某些患者 PMN 进展的临床危险因素包括血管侵犯、肺外转移、低肿瘤细胞坏死率和大肿瘤。放射学危险因素包括最大直径、距胸膜的距离、CT 值、实性成分和光滑边界。

结论

PMN 在骨肉瘤患者中很常见。PMN进展与某些临床和放射学因素有关，这可以帮助外科医生确定其早期进展的可能性。