Ahn Yura, Lee Sang Min, Kim Min Seon, Choi Sehoon, Kim Seonok, Do Kyung-Hyun, Seo Joon Beom
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea.
Department of Cardiothoracic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
AJR Am J Roentgenol. 2022 Apr;218(4):624-632. doi: 10.2214/AJR.21.26859. Epub 2021 Nov 3.
Pulmonary metastases of bone and soft-tissue sarcoma are common and have a high recurrence rate after metastasectomy. Factors associated with postmetastasectomy recurrence are not well studied. The purpose of this study was to investigate the association of the volume doubling time (VDT) of pulmonary metastases with the subsequent development of new pulmonary nodules and survival after metastasectomy in patients with bone or soft-tissue sarcoma. This retrospective study included patients with bone or soft-tissue sarcoma who, between January 2010 and December 2020, underwent first complete metastasectomy of pulmonary nodules visualized on two sequential preoperative CT scans. Semiautomatic volumetric segmentation of the pulmonary metastases was performed on the two CT scans, and VDTs were calculated. VDT was compared between patients with and without subsequent new metastases after metastasectomy. Cox proportional hazards regression analyses were performed to determine risk factors for recurrence-free survival (RFS) after metastasectomy and for postmetastasectomy overall survival (OS). Forty patients (21 women, 19 men; mean age, 51.1 ± 14.3 [SD] years) were included. Of these patients, 23 (57.5%) developed new metastatic nodules after metastasectomy, and 10 (25.0%) died during follow-up. Median VDT was shorter in patients with, versus those without, new metastases after metastasectomy (56 vs 140 days, = .002). Only four of 23 patients with new metastases had VDT of 140 days or more. In multivariable analysis, older age (hazard ratio [HR], 1.06; = .004), female sex (HR, 2.80; = .03), and VDT less than 140 days (HR, 4.22; = .01) were independent predictors of worse RFS. Also in multivariable analysis, only older age (HR, 1.17; = .005) and VDT less than 50 days (HR, 8.60; = .02) were independent predictors of worse OS. OS was significantly worse in patients with VDT less than 140 days (10 deaths among 27 patients) than in patients with VDT of 140 days or more (no deaths in 13 patients) ( = .01). In patients with bone and soft-tissue sarcoma, shorter VDT of pulmonary metastases is independently associated with subsequent new metastases after metastasectomy and worse OS. VDT of pulmonary nodules may be considered in patient selection for pulmonary metastasectomy and in postoperative patient management.
骨与软组织肉瘤的肺转移很常见，肺转移瘤切除术后复发率高。与转移瘤切除术后复发相关的因素尚未得到充分研究。本研究的目的是探讨骨或软组织肉瘤患者肺转移瘤的体积倍增时间（VDT）与肺转移瘤切除术后新肺结节的发生及生存之间的关系。这项回顾性研究纳入了2010年1月至2020年12月期间接受首次完整肺转移瘤切除术的骨或软组织肉瘤患者，这些转移瘤在术前连续两次CT扫描中均可见。对两次CT扫描的肺转移瘤进行半自动体积分割，并计算VDT。比较肺转移瘤切除术后有或无新转移灶患者的VDT。进行Cox比例风险回归分析，以确定转移瘤切除术后无复发生存期（RFS）和转移瘤切除术后总生存期（OS）的危险因素。共纳入40例患者（21例女性，19例男性；平均年龄51.1±14.3[标准差]岁）。在这些患者中，23例（57.5%）在肺转移瘤切除术后出现新的转移结节，10例（25.0%）在随访期间死亡。肺转移瘤切除术后有新转移灶的患者的VDT中位数短于无新转移灶的患者（56天对140天，P = 0.002）。23例有新转移灶的患者中只有4例VDT为140天或更长。在多变量分析中，年龄较大（风险比[HR]，1.06；P = 0.004）、女性（HR，2.80；P = 0.03）和VDT小于140天（HR，4.22；P = 0.01）是RFS较差的独立预测因素。同样在多变量分析中，只有年龄较大（HR，1.17；P = 0.005）和VDT小于50天（HR，8.60；P = 0.02）是OS较差的独立预测因素。VDT小于140天的患者的OS明显差于VDT为140天或更长的患者（27例患者中有10例死亡）（13例患者中无死亡）（P = 0.01）。在骨与软组织肉瘤患者中，肺转移瘤的VDT较短与肺转移瘤切除术后随后出现新转移灶及较差的OS独立相关。在选择肺转移瘤切除术的患者和术后患者管理中可考虑肺结节的VDT。
