1 University of Amsterdam, Amsterdam, the Netherlands.
10 Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
J Clin Oncol. 2019 Mar 20;37(9):723-730. doi: 10.1200/JCO.18.01535. Epub 2019 Jan 31.
To evaluate the clinical significance of indeterminate pulmonary nodules at diagnosis (defined as ≤ 4 pulmonary nodules < 5 mm or 1 nodule measuring ≥ 5 and < 10 mm) in patients with pediatric rhabdomyosarcoma (RMS).
We selected patients with supposed nonmetastatic RMS treated in large pediatric oncology centers in the United Kingdom, France, Italy, and the Netherlands, who were enrolled in the European Soft Tissue Sarcoma Study Group (E pSSG) RMS 2005 study. Patients included in the current study received a diagnosis between September 2005 and December 2013, and had chest computed tomography scans available for review that were done at time of diagnosis. Local radiologists were asked to review the chest computed tomography scans for the presence of pulmonary nodules and to record their findings on a standardized case report form. In the E pSSG RMS 2005 Study, patients with indeterminate pulmonary nodules were treated identically to patients without pulmonary nodules, enabling us to compare event-free survival and overall survival between groups by log-rank test.
In total, 316 patients were included; 67 patients (21.2%) had indeterminate pulmonary nodules on imaging and 249 patients (78.8%) had no pulmonary nodules evident at diagnosis. Median follow-up for survivors (n = 258) was 75.1 months; respective 5-year event-free survival and overall survival rates (95% CI) were 77.0% (64.8% to 85.5%) and 82.0% (69.7% to 89.6%) for patients with indeterminate nodules and 73.2% (67.1% to 78.3%) and 80.8% (75.1% to 85.3%) for patients without nodules at diagnosis ( P = .68 and .76, respectively).
Our study demonstrated that indeterminate pulmonary nodules at diagnosis do not affect outcome in patients with otherwise localized RMS. There is no need to biopsy or upstage patients with RMS who have indeterminate pulmonary nodules at diagnosis.
评估儿科横纹肌肉瘤（RMS）患者诊断时（定义为≤4 个<5 毫米的肺结节或 1 个≥5 且<10 毫米的结节）的不确定肺结节的临床意义。
我们选择了在英国、法国、意大利和荷兰的大型儿科肿瘤中心接受疑似非转移性 RMS 治疗的患者，并将其纳入欧洲软组织肉瘤研究组（E pSSG）RMS 2005 研究。当前研究纳入的患者于 2005 年 9 月至 2013 年 12 月间确诊，并进行了胸部计算机断层扫描（CT）检查。当地放射科医生被要求审查胸部 CT 扫描以确定是否存在肺结节，并在标准化病例报告表上记录其发现。在 E pSSG RMS 2005 研究中，具有不确定肺结节的患者与无肺结节的患者接受了相同的治疗，使我们能够通过对数秩检验比较两组之间的无事件生存和总生存。
共纳入 316 例患者；67 例（21.2%）影像学上有不确定肺结节，249 例（78.8%）无诊断时的肺结节。幸存者（n=258）的中位随访时间为 75.1 个月；分别有不确定结节患者的 5 年无事件生存率和总生存率（95%CI）为 77.0%（64.8%至 85.5%）和 82.0%（69.7%至 89.6%），无结节患者为 73.2%（67.1%至 78.3%）和 80.8%（75.1%至 85.3%）（P=分别为.68 和.76）。
我们的研究表明，诊断时的不确定肺结节不会影响局部 RMS 患者的结局。对于诊断时具有不确定肺结节的 RMS 患者，无需进行活检或升级分期。
