Paioli Anna, Rocca Michele, Cevolani Luca, Rimondi Eugenio, Vanel Daniel, Palmerini Emanuela, Cesari Marilena, Longhi Alessandra, Eraldo Abate Massimo, Marchesi Emanuela, Picci Piero, Ferrari Stefano
Chemotherapy Unit, Istituto Ortopedico Rizzoli, via Pupilli, 1, 40136 Bologna, Italy.
General Surgery Unit, Istituto Ortopedico Rizzoli, via Pupilli, 1, 40136 Bologna, Italy.
Clin Sarcoma Res. 2017 Feb 14;7:3. doi: 10.1186/s13569-017-0067-5. eCollection 2017.
In patients with relapsed osteosarcoma, the surgical excision of all metastases, defined as second complete remission (CR-2), is the factor that mainly influences post-relapse survival (PRS). Currently a validated follow-up policy for osteosarcoma is not available, both chest X-ray and computed tomography (CT) are suggested for lung surveillance. The purpose of this study is to evaluate whether the type of imaging technique used for chest surveillance, chest X-ray or CT, influenced the rate of CR-2 and prognosis in patients with recurrent osteosarcoma.
Patients up to 40 years with extremity osteosarcoma enrolled in consecutive clinical trials and treated at the Rizzoli Institute from 1986 to 2009 were identified. Only patients who had lung metastases alone as first pattern of recurrence were considered for the analysis. The rate of CR-2, overall survival (OS) and PRS were the end-points of the study.
The median follow-up was 47 months (1-300), 215 patients were eligible. Lung metastases were detected by chest X-ray in 100 (47%) patients, by CT in 112 (52%) and by symptoms in 3 (1%). CR-2 rate was 60% for patients followed by X-rays and 88% for those followed by CT (p < .0001). 5-year PRS was 30% (95% CI 21-39) in the X-ray group and 49% (95% CI 39-59) in the CT group (p = .0004). 5-year OS was 35% (95% CI 26-44) in the X-ray group and 60% (95% CI 51-70) in the CT group (p = .004).
A follow-up strategy with chest CT leads to a higher rate of CR-2 and significantly improves PRS and OS in osteosarcoma, compared to chest X-ray.
在复发性骨肉瘤患者中，将所有转移灶的手术切除定义为第二次完全缓解（CR-2），这是主要影响复发后生存（PRS）的因素。目前尚无经过验证的骨肉瘤随访策略，胸部X线和计算机断层扫描（CT）均被建议用于肺部监测。本研究的目的是评估用于胸部监测的成像技术类型，即胸部X线或CT，是否会影响复发性骨肉瘤患者的CR-2率和预后。
确定1986年至2009年在里佐利研究所参加连续临床试验并接受治疗的40岁以下肢体骨肉瘤患者。仅将以单独肺转移作为首次复发模式的患者纳入分析。研究终点为CR-2率、总生存期（OS）和PRS。
中位随访时间为47个月（1-300个月），215例患者符合条件。100例（47%）患者通过胸部X线检测到肺转移，112例（52%）通过CT检测到，3例（1%）通过症状检测到。接受X线随访的患者CR-2率为60%，接受CT随访的患者为88%（p<0.0001）。X线组5年PRS为30%（95%CI 21-39），CT组为49%（95%CI 39-59）（p=0.0004）。X线组5年OS为35%（95%CI 26-44），CT组为60%（95%CI 51-70）（p=0.004）。
与胸部X线相比，胸部CT随访策略可使骨肉瘤患者的CR-2率更高，并显著改善PRS和OS。
