Rissing Stacy, Rougraff Bruce T, Davis Kenneth
Department of Radiology, Indiana University Hospital, Indianapolis, IN, USA.
Clin Orthop Relat Res. 2007 Jun;459:118-21. doi: 10.1097/BLO.0b013e31805d8606.
We prospectively studied 331 sarcoma patients treated between April 1999 and December 2004 to see if small, indeterminate pulmonary nodules are of prognostic significance. Seventy-one (21%) had indeterminate pulmonary nodules on initial spiral CCT. Twenty of 71 (28%) patients with indeterminate nodules progressed with metastatic disease. Metastatic disease developed in 18/20 (90%) in the area of the original indeterminate nodule. The presence of tiny (<5 mm) indeterminate nodules was not a prognostic variable, however, the presence of nodules > or =5 mm was associated with worse 3 year disease-free survival compared to those with no nodules or tiny nodules (81% versus 49%) but better than those with definite metastatic disease at presentation (49% versus 5%). Because patients with pulmonary nodules > or =5 mm are at increased risk for metastatic disease compared to patients with normal CCT or those with <5 mm nodules but better survival than patients with Stage IV disease, we believe a new staging system of these patients should be considered and recommend careful followup.
我们前瞻性地研究了1999年4月至2004年12月期间接受治疗的331例肉瘤患者，以确定肺部小的、不明确的结节是否具有预后意义。71例（21%）患者在初次螺旋CT检查时有不明确的肺部结节。71例中有20例（28%）有不明确结节的患者发生了转移性疾病进展。18/20（90%）在原来不明确结节的区域发生了转移性疾病。微小（<5mm）不明确结节的存在不是一个预后变量，然而，与无结节或微小结节的患者相比，≥5mm结节的存在与3年无病生存率较差相关（81%对49%），但比初诊时有明确转移性疾病的患者要好（49%对5%）。由于与CT正常或结节<5mm的患者相比，肺部结节≥5mm的患者发生转移性疾病的风险增加，但生存率优于IV期疾病患者，我们认为应考虑对这些患者采用新的分期系统，并建议进行仔细的随访。
