Davison Reid, Hamati Fadi, Kent Paul
Rush University Medical College, Chicago, IL 60612, USA.
Rush Medical Center, Pediatric Hematology/Oncology, Rush University Medical Center, Chicago, IL 60612, USA.
J Clin Med. 2021 Mar 15;10(6):1213. doi: 10.3390/jcm10061213.
For osteosarcoma, staging criteria, prognosis estimates, and surgical recommendations have not yet changed to reflect increasingly sensitive computed tomography (CT) imaging. However, the frequent identification of micronodules (<5 mm) on presentation leaves clinicians in a difficult position regarding the need to biopsy, resect, or follow the lesions and whether to consider the patient metastatic or non-metastatic. Our objective was to compare the 5-year overall survival rates of patients with osteosarcoma with non-surgically resected lung micronodules on presentation to patients without micronodules to guide community oncologists faced with this common dilemma. We collected data retrospectively on all newly diagnosed osteosarcoma patients, aged less than 50, treated at Rush University Hospital over 25 years without pulmonary nodules >10 mm or pulmonary surgical intervention. Kaplan-Meier curves showed there was no difference in 5-year overall survival in patients with any size nodule <5 mm compared to patients with no nodules. Additionally, our study showed a survival advantage for those who presented with 0 or 1 nodule (90%) compared to ≥2 nodules (53%). Our data suggest surgery may not be necessary for singular nodules <5 mm identified on presentation, and that these patients behave more like "localized" patients than metastatic patients.
对于骨肉瘤，分期标准、预后评估和手术建议尚未改变以反映日益敏感的计算机断层扫描（CT）成像。然而，在初诊时频繁发现微小结节（<5mm），这让临床医生在是否需要对这些病变进行活检、切除或随访，以及是否将患者视为转移性或非转移性方面陷入困境。我们的目的是比较初诊时存在未行手术切除的肺部微小结节的骨肉瘤患者与无微小结节患者的5年总生存率，以指导面临这一常见困境的社区肿瘤学家。我们回顾性收集了在拉什大学医院接受治疗的所有年龄小于50岁、25年来新诊断的骨肉瘤患者的数据，这些患者无大于10mm的肺结节或肺手术干预。Kaplan-Meier曲线显示，与无结节的患者相比，任何大小<5mm结节的患者5年总生存率无差异。此外，我们的研究表明，初诊时出现0个或1个结节的患者（90%）比出现≥2个结节的患者（53%）有生存优势。我们的数据表明，对于初诊时发现的单个<5mm结节，手术可能没有必要，而且这些患者的表现更像“局限性”患者而非转移性患者。
