Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Bone Joint J. 2024 Aug 1;106-B(8):865-870. doi: 10.1302/0301-620X.106B8.BJJ-2023-1333.R1.
Venous tumour thrombus (VTT) is a rare finding in osteosarcoma. Despite the high rate of VTT in osteosarcoma of the pelvis, there are very few descriptions of VTT associated with extrapelvic primary osteosarcoma. We therefore sought to describe the prevalence and presenting features of VTT in osteosarcoma of both the pelvis and the limbs.
Records from a single institution were retrospectively reviewed for 308 patients with osteosarcoma of the pelvis or limb treated between January 2000 and December 2022. Primary lesions were located in an upper limb (n = 40), lower limb (n = 198), or pelvis (n = 70). Preoperative imaging and operative reports were reviewed to identify patients with thrombi in proximity to their primary lesion. Imaging and histopathology were used to determine presence of tumour within the thrombus.
Tumours abutted the blood vessels in 131 patients (43%) and encased the vessels in 30 (10%). Any form of venous thrombus was identified in 31 patients (10%). Overall, 21 of these thrombi were determined to be involved with the tumour based on imaging (n = 9) or histopathology (n = 12). The rate of VTT was 25% for pelvic osteosarcoma and 1.7% for limb osteosarcoma. The most common imaging features associated with histopathologically proven VTT were enhancement with contrast (n = 12; 100%), venous enlargement (n = 10; 83%), vessel encasement (n = 8; 66%), and visible intraluminal osteoid matrix (n = 6; 50%). Disease-specific survival (DSS) for patients with VTT was 95% at 12 months (95% CI 0.87 to 1.00), 50% at three years (95% CI 0.31 to 0.80), and 31% at five years (95% CI 0.14 to 0.71). VTT was associated with worse DSS (hazard ratio 2.3 (95% CI 1.11 to 4.84).
VTT is rare with osteosarcoma and occurs more commonly in the pelvis than the limbs. Imaging features suggestive of VTT include enhancement with contrast, venous dilation, and vessel encasement. VTT portends a worse prognosis for patients with osteosarcoma, with a similar survivability to metastatic disease.
静脉肿瘤血栓（VTT）在骨肉瘤中较为罕见。尽管骨盆骨肉瘤中 VTT 的发生率很高，但很少有关于与骨盆外原发性骨肉瘤相关的 VTT 的描述。因此，我们旨在描述骨盆和四肢骨肉瘤中 VTT 的发生率和临床表现。
回顾性分析 2000 年 1 月至 2022 年 12 月期间在我院治疗的 308 例骨盆或四肢骨肉瘤患者的病历资料。原发灶位于上肢（n=40）、下肢（n=198）或骨盆（n=70）。对术前影像学和手术报告进行了审查，以确定靠近原发性病变的血栓患者。影像学和组织病理学用于确定血栓内是否存在肿瘤。
131 例患者（43%）的肿瘤紧贴血管，30 例患者（10%）的肿瘤包裹血管。31 例患者（10%）发现任何形式的静脉血栓。总的来说，基于影像学（n=9）或组织病理学（n=12），其中 21 例血栓与肿瘤有关。骨盆骨肉瘤 VTT 发生率为 25%，四肢骨肉瘤 VTT 发生率为 1.7%。与经组织病理学证实的 VTT 相关的最常见影像学特征包括增强对比（n=12；100%）、静脉扩大（n=10；83%）、血管包裹（n=8；66%）和可见腔内骨样基质（n=6；50%）。VTT 患者的疾病特异性生存率（DSS）为 12 个月时为 95%（95%CI 0.87 至 1.00），3 年时为 50%（95%CI 0.31 至 0.80），5 年时为 31%（95%CI 0.14 至 0.71）。VTT 与较差的 DSS 相关（风险比 2.3（95%CI 1.11 至 4.84））。
VTT 在骨肉瘤中较为罕见，骨盆较四肢更为常见。提示 VTT 的影像学特征包括增强对比、静脉扩张和血管包裹。VTT 预示着骨肉瘤患者预后较差，与转移性疾病的生存率相似。
