1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
AJR Am J Roentgenol. 2017 Aug;209(2):409-416. doi: 10.2214/AJR.16.17466. Epub 2017 Jun 7.
The objective of this study is to evaluate patterns of distant metastasis and identified factors that may increase the risk of distant metastasis in pediatric patients with rhabdomyosarcoma.
This retrospective study included 69 patients (age, ≤ 20 years) who had rhabdomyosarcoma diagnosed between January 2000 and February 2016. Various imaging features, including distant metastasis, were evaluated on initial and follow-up imaging studies. Differences in the distribution of distant metastasis on the basis of the primary location were analyzed. Logistic regression analysis was performed to identify factors associated with distant metastasis.
Twenty-six of the 69 patients (37.7%) had distant metastasis. Nineteen of the 26 patients had distant metastasis noted at initial presentation, and 15 of the 26 patients had new metastasis noted during follow-up. The most common site of metastasis was bone (n = 14), followed by lung (n = 12) and distant lymph nodes (n = 9). Lymph node metastasis more frequently developed in patients with primary rhabdomyosarcoma in an extremity than in patients with primary rhabdomyosarcoma that developed at other sites (p = 0.003). Of 15 patients who had metastasis during follow-up, nine (60%) did not appear to have simultaneous locoregional recurrence at the time of the discovery of distant metastasis. Older age at presentation and unfavorable sites of the primary tumor were significantly associated with distant metastasis in multivariate analysis.
Distant metastasis of rhabdomyosarcomas in pediatric patients showed different patterns according to the location of the primary tumor and even occurred without local recurrence.
本研究旨在评估儿童横纹肌肉瘤远处转移的模式，并确定可能增加远处转移风险的因素。
本回顾性研究纳入了 2000 年 1 月至 2016 年 2 月期间诊断为横纹肌肉瘤的 69 例（年龄≤20 岁）患者。评估了初始和随访影像学研究中包括远处转移在内的各种影像学特征。分析了基于原发部位的远处转移分布差异。采用逻辑回归分析确定与远处转移相关的因素。
69 例患者中，26 例（37.7%）发生远处转移。26 例中有 19 例在初始表现时就出现远处转移，有 15 例在随访期间出现新的转移。最常见的转移部位是骨骼（n=14），其次是肺（n=12）和远处淋巴结（n=9）。原发于四肢的横纹肌肉瘤患者较其他部位原发的横纹肌肉瘤患者更易发生淋巴结转移（p=0.003）。在 15 例随访期间发生转移的患者中，有 9 例（60%）在发现远处转移时似乎没有同时出现局部区域复发。在多变量分析中，发病时年龄较大和肿瘤原发部位不良与远处转移显著相关。
儿童横纹肌肉瘤的远处转移模式根据原发肿瘤的部位而不同，甚至在没有局部复发的情况下也会发生远处转移。
