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How to confront the high prevalence of pulmonary micro nodules (PMNs) in osteosarcoma patients?

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A Letter to the Editor to this article was published on 26 September 2022

Abstract

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.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the grant from the National Natural Science Foundation of China (82103223).

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Authors

Contributions

Study design: Wei Guo. Data acquisition: Zhenyu Cai, Jie Xu, and Xin Sun. Analysis and interpretation of data: Zhenyu Cai, Ranxin Zhang, Lu Xie, Jichuan Wang. Drafting and critical revision: Zhenyu Cai, Jie Xu, Xiaodong Tang, Rongli Yang, and Wei Guo.

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Correspondence to Wei Guo.

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Each author certifies that the study had obtained the approval from institutional review board of People’s Hospital, Peking University. The investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in such type of study was obtained at admission. No specific IRB certification is needed for retrospective view of clinical cases at our institution. If further certificate is needed, we would like to provide at any time.

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Since our institution is a university-affiliated hospital, all the inpatient patients need to sign a consent at admission, indicating their information; sample or tissue may be used for educational, research purpose. For a retrospective study, no specific consent is needed for data collection and publication according to regulation at the authors’ institutional.

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The authors declare no competing interests.

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Level of evidence: III, Prognostic study

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Cai, Z., Xu, J., Sun, X. et al. How to confront the high prevalence of pulmonary micro nodules (PMNs) in osteosarcoma patients?. International Orthopaedics (SICOT) 46, 2425–2436 (2022). https://doi.org/10.1007/s00264-022-05534-7

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