Department of Visceral and Neonatal Pediatric Surgery, Sorbonne Université, APHP - Hôpital Trousseau, Paris, France.
Department of Pediatric Onco-Hematology, APHP - Hôpital Trousseau, Paris, France.
Pediatr Blood Cancer. 2022 Sep;69(9):e29725. doi: 10.1002/pbc.29725. Epub 2022 Apr 22.
Resection of all lung metastases in patients with osteosarcoma improves survival. The increased computed tomography (CT) scan quality allows detecting smaller nodules. We aimed to evaluate the prognostic impact of those nodules that do not meet the classical criteria for lung metastases.
A central radiology review (CRR) on lung CT scans performed during the treatment of patients included in OS2006 trial and treated with a high-dose methotrexate-based chemotherapy from 2007 to 2013 was realized in three centers.
At trial enrollment, among 77 patients, six (8%) had nodules meeting the trial's criteria for metastatic disease, 46 (60%) were classified as having localized disease, and 25 (32%) as having doubtful nodules. After CRR, 218 nodules were found at diagnosis (all in patients classified as "metastatic or doubtful" and 13 patients classified as "localized") (median two nodules per patient [1-52]). The 5-year event-free survival/overall survival (EFS/OS) of patients with at least one nodule versus no nodule were similar (67.7%/79.2% vs. 81.8%/91%). After histological analysis, two of 46 (4.3%) "localized" and eight of 25 (32.0%) "doubtful" patients were re-classified as "metastatic," whereas there was no change in patients initially "metastatic." The 5-year OS of confirmed histological metastatic versus nonmetastatic patients were different (56% vs. 92%, p < .01).
Central review of lung CT scan increased the detection of nodules in osteosarcoma. Patients with small lung nodules classified as doubtful had a quite similar outcome as those with a localized disease. However, patients with confirmed metastatic nodules have a poorer prognosis, even if considered as "localized" at diagnosis.
骨肉瘤患者肺部所有转移灶的切除可提高生存率。增强的计算机断层扫描（CT）质量可检测到更小的结节。我们旨在评估那些不符合肺部转移经典标准的结节的预后影响。
对纳入 OS2006 试验的患者在治疗期间进行的肺部 CT 扫描进行了中央放射学审查（CRR），这些患者于 2007 年至 2013 年接受了大剂量甲氨蝶呤为基础的化疗。
在试验入组时，77 例患者中，6 例（8%）有符合转移性疾病试验标准的结节，46 例（60%）归类为局限性疾病，25 例（32%）归类为可疑结节。在 CRR 后，诊断时发现了 218 个结节（均在归类为“转移性或可疑性”的患者中发现，13 例归类为“局限性”）（中位数每位患者两个结节[1-52]）。至少有一个结节的患者与无结节的患者 5 年无事件生存率/总生存率（EFS/OS）相似（67.7%/79.2%vs.81.8%/91%）。经过组织学分析，46 例“局限性”中有 2 例（4.3%）和 25 例“可疑性”中有 8 例（32.0%）重新归类为“转移性”，而最初归类为“转移性”的患者没有变化。经组织学证实的转移性与非转移性患者的 5 年 OS 不同（56%vs.92%，p<0.01）。
对肺部 CT 扫描的中央审查增加了骨肉瘤中结节的检出率。肺部小结节被归类为可疑性的患者与具有局限性疾病的患者的结果相当。然而，经组织学证实的转移性结节患者的预后较差，即使在诊断时被归类为“局限性”。
