Journal of Bone Oncology最新文献

{"title":"Artificial Intelligence in bone Metastases: A systematic review in guideline adherence of 92 studies","authors":"Lotte R. van der Linden ,&nbsp;Ioannis Vavliakis ,&nbsp;Tom M. de Groot ,&nbsp;Paul C. Jutte ,&nbsp;Job N. Doornberg ,&nbsp;Santiago A. Lozano-Calderon ,&nbsp;Olivier Q. Groot","doi":"10.1016/j.jbo.2025.100682","DOIUrl":"10.1016/j.jbo.2025.100682","url":null,"abstract":"<div><h3>Background</h3><div>The last decade has witnessed a surge in artificial intelligence (AI). With bone metastases becoming more prevalent, there is an increasing call for personalized treatment options, a domain where AI can greatly contribute. However, integrating AI into clinical settings has proven to be difficult. Therefore, we aimed to provide an overview of AI modalities for treating bone metastases and recommend implementation-worthy models based on TRIPOD, CLAIM, and UPM scores.</div></div><div><h3>Methods</h3><div>This systematic review included 92 studies on AI models in bone metastases between 2008 and 2024. Using three assessment tools we provided a reliable foundation for recommending AI modalities fit for clinical use (TRIPOD or CLAIM ≥ 70 % and UPM score ≥ 10).</div></div><div><h3>Results</h3><div>Most models focused on survival prediction (44/92;48%), followed by imaging studies (37/92;40%). Median TRIPOD completeness was 70% (IQR 64–81%), CLAIM completeness was 57% (IQR 48–67%), and UPM score was 7 (IQR 5–9). In total, 10% (9/92) AI modalities were deemed fit for clinical use.</div></div><div><h3>Conclusion</h3><div>Transparent reporting, utilizing the aforementioned three evaluation tools, is essential for effectively integrating AI models into clinical practice, as currently, only 10% of AI models for bone metastases are deemed fit for clinical use. Such transparency ensures that both patients and clinicians can benefit from clinically useful AI models, potentially enhancing AI-driven personalized cancer treatment.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100682"},"PeriodicalIF":3.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting lung cancer bone metastasis using CT and pathological imaging with a Swin Transformer model","authors":"Wanling Li ,&nbsp;Xin Zou ,&nbsp;Jie Zhang ,&nbsp;Minghong Hu ,&nbsp;Guanfeng Chen ,&nbsp;Shanshan Su","doi":"10.1016/j.jbo.2025.100681","DOIUrl":"10.1016/j.jbo.2025.100681","url":null,"abstract":"<div><div>Bone metastasis is a common and serious complication in lung cancer patients, leading to severe pain, pathological fractures, and reduced quality of life. Early prediction of bone metastasis can enable timely interventions and improve patient outcomes. In this study, we developed a multimodal Swin Transformer-based deep learning model for predicting bone metastasis risk in lung cancer patients by integrating CT imaging and pathological data. A total of 215 patients with confirmed lung cancer diagnoses, including those with and without bone metastasis, were included. The model was designed to process high-resolution CT images and digitized histopathological images, with the features extracted independently by two Swin Transformer networks. These features were then fused using decision-level fusion techniques to improve classification accuracy. The Swin-Dual Fusion Model achieved superior performance compared to single-modality models and conventional architectures such as ResNet50, with an AUC of 0.966 on the test data and 0.967 on the training data. This integrated model demonstrated high accuracy, sensitivity, and specificity, making it a promising tool for clinical application in predicting bone metastasis risk. The study emphasizes the potential of transformer-based models to revolutionize bone oncology through advanced multimodal analysis and early prediction of metastasis, ultimately improving patient care and treatment outcomes.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100681"},"PeriodicalIF":3.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of preoperative hematocrit and platelet count with morbidity after pathologic fracture fixation","authors":"Mohyeddine El Sayed ,&nbsp;Ryley Zastrow ,&nbsp;Sassine Youssef ,&nbsp;Adam S. Levin","doi":"10.1016/j.jbo.2025.100679","DOIUrl":"10.1016/j.jbo.2025.100679","url":null,"abstract":"<div><h3>Background</h3><div>Anemia and abnormal platelet count are common among patients with cancer and are associated with complications after orthopaedic procedures. We studied associations between these conditions and morbidity within 30 days after surgery for pathologic femur or humerus fracture.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed data from the National Surgery Quality Improvement Project database for 145,030 adults following surgical fixation of a pathologic femur or humerus fracture from 2010 to 2020. Multivariable logistic regressions compared 30-day complications between patients with mild or severe anemia versus those with normal hematocrit and between patients with thrombocytopenia or thrombocytosis versus those with normal platelet count.</div></div><div><h3>Results</h3><div>Likelihood of extended hospitalization (≥6 days) was higher in patients with mild anemia (odds ratio [OR]: 1.47; 95 % confidence interval [CI]: 1.44, 1.51) and severe anemia (OR: 2.14; 95 % CI: 2.06, 2.23). Likelihood of all-cause morbidity was also higher among those with mild anemia (OR: 1.17; 95 % CI: 1.13, 1.21) and severe anemia (OR: 1.35; 95 % CI: 1.28, 1.42). Similarly, likelihood of extended hospitalization was higher in patients with thrombocytopenia (OR: 1.25; 95 % CI: 1.22, 1.29) and thrombocytosis (OR: 1.24; 95 % CI: 1.13, 1.36). Likelihood of all-cause morbidity was also higher for those with thrombocytopenia (OR: 1.12; 95 % CI: 1.07, 1.16) and thrombocytosis (OR: 1.21; 95 % CI: 1.07, 1.37).</div></div><div><h3>Conclusion</h3><div>Preoperative anemia and platelet abnormalities were potentially modifiable risk factors associated with postoperative complications following surgery for pathologic fracture.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100679"},"PeriodicalIF":3.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of myeloma bone disease: When, how often, and for how long?","authors":"Michael Tveden Gundesen ,&nbsp;Fredrik Schjesvold ,&nbsp;Thomas Lund","doi":"10.1016/j.jbo.2025.100680","DOIUrl":"10.1016/j.jbo.2025.100680","url":null,"abstract":"<div><div>The landscape of MM has changed dramatically in recent years. Several new and more effective treatments have been introduced that not only makes patients live longer but also brings them into a deeper remission. This makes the potential total exposure of bone protective treatment much higher but perhaps also less needed. New and more precise imagining techniques have been introduced making detection of bone disease more sensitive, and the introduction of SLiM-CRAB criteria have changed the parameters used in old clinical trials investigating treatment of MM bone disease. New data have also emerged investigating the effect of the RANKL inhibitor denosumab compared to zoledronic acid (ZOL). Randomized trials have investigated longer treatment durations, which becomes more relevant as patients now live longer.</div><div>In addition in this review, data regarding interval between individual treatment, impact of remission status, new data in relation to rebound after discontinuation and of denosumab, as well as the rational for drug holidays before dental procedures will also be discussed.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100680"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding the immune landscape in Ewing sarcoma pathogenesis: The role of tumor infiltrating immune cells and immune milieu","authors":"Rajiv Ranjan Kumar ,&nbsp;Nikita Agarwal ,&nbsp;Akshi Shree ,&nbsp;Jaya Kanta Gorain ,&nbsp;Ekta Rahul ,&nbsp;Shuvadeep Ganguly ,&nbsp;Sameer Bakhshi ,&nbsp;Uttam Sharma","doi":"10.1016/j.jbo.2025.100678","DOIUrl":"10.1016/j.jbo.2025.100678","url":null,"abstract":"<div><div>Ewing sarcoma (EwS) is the second most prevalent pediatric bone malignancy, characterized by its aggressive behavior and unfavorable prognosis. The tumor microenvironment (TME) of EwS is shaped by immunosuppressive components, including myeloid-derived suppressor cells, tumor-associated macrophages, and immune checkpoint molecules such as PD-1/PD-L1 and HLA-G. These elements impair anti-tumor immune responses by modulating the function of tumor-infiltrating immune cells, such as regulatory T cells (Tregs), CD8⁺ T cells, and natural killer cells. Chemokines, including CXCL9 and CXCL12, and cytokines, such as transforming growth factor-beta and interleukin-10, further contribute to immune suppression and promote metastatic dissemination. Recent advances in immunotherapy have highlighted the therapeutic potential of modulating immune cells and signaling pathways to enhance anti-tumor immunity. This review provides a comprehensive analysis of the complex immune landscape within the EwS TME, focusing on the mechanistic roles of key immune components and their potential as therapeutic targets. Understanding these interactions could pave the way for innovative treatment strategies to improve clinical outcomes in patients with EwS.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100678"},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone cement implantation syndrome in patients with cemented endoprostheses for metastatic bone disease in the femur","authors":"Thea Hovgaard Ladegaard ,&nbsp;Jakob Stensballe ,&nbsp;Michael Mørk Petersen ,&nbsp;Michala Skovlund Sørensen","doi":"10.1016/j.jbo.2025.100677","DOIUrl":"10.1016/j.jbo.2025.100677","url":null,"abstract":"<div><h3>Background</h3><div>Patients with bone metastases in the femur (BMf) may experience pathological fractures requiring surgery with cemented endoprostheses (EPR). At cementation and prosthesis insertion, patients are at risk of experiencing hypoxia, hypotension, cardiac failure and potentially death, known as bone cement implantation syndrome (BCIS). We aimed to 1) investigate the incidence and grade of BCIS in patients with BMf treated with cemented EPR, and 2) examine if the incidence or extent of BCIS has decreased after a change of a combined anesthesiologic and surgical protocol.</div></div><div><h3>Methods</h3><div>We retrospectively assessed patients with BMf operated with cemented EPR in two periods 2017 – 2018 (early cohort) and 2019 – 2020 (late cohort) and stratified before and after the intervention.</div></div><div><h3>Results</h3><div>Comparing the early and late cohorts, 26/86 (32 %) vs. 30/80 (35 %) experienced BCIS, but mild BCIS (grade 0 + 1) was seen in 79 % vs. 86 %, and severe BCIS (grade 2 + 3) in 21 % vs. 14 %. In the late cohort the per-operative use of vasopressors was higher (86 % vs. 59 %, p &lt; 0.001), we found fewer pulmonary embolisms (PE) (p = 0.024), and a trend toward a reduced length of stay (LOS). 30-day survival was lower for patients with grade 0 + 1 compared to grade 2 + 3 (p = 0.03).</div></div><div><h3>Conclusions</h3><div>BCIS occurs in more than 1/3 of patients operated for BMf with cemented EPR. An increased multidisciplinary focus on BCIS may reduce the complications of BCIS, such as PE and LOS.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100677"},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of spinal metastases: A cross-continental study in the United States and the Netherlands","authors":"Jantijn J.G.J. Amelink ,&nbsp;Bram T. van Munster ,&nbsp;Bas J.J. Bindels ,&nbsp;Robertus J.B. Pierik ,&nbsp;Jasper van Tiel ,&nbsp;Olivier Q. Groot ,&nbsp;Nicolien Kasperts ,&nbsp;Daniel G. Tobert ,&nbsp;Jorrit-Jan Verlaan","doi":"10.1016/j.jbo.2025.100676","DOIUrl":"10.1016/j.jbo.2025.100676","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no consensus on the optimal surgical treatment for patients with spinal metastases. Investigating regional variations in surgical management could provide valuable insights to optimize care and refine surgical practices globally.</div></div><div><h3>Objective</h3><div>To investigate differences in patient populations, surgical management, and perioperative outcomes among patients who underwent surgery for spinal metastases in either Boston (United States) or Utrecht (Netherlands).</div></div><div><h3>Methods</h3><div>727 patients surgically treated for spinal metastases in Boston (n=539) and Utrecht (n=188) between 2018–2022 were included. Data on patient characteristics, surgical management, perioperative outcomes, and survival were collected. The Mann-Whitney <em>U</em> test was used for continuous data, and Fisher’s exact test for categorical data.</div></div><div><h3>Results</h3><div>In Boston, a higher percentage of patients had three or more spinal metastases (68% <em>vs</em> 59%; p=0.006) and brain metastases (16% <em>vs</em> 4.3%; p&lt;0.001) at the time of surgery compared with Utrecht. Vertebrectomy/corpectomy with stabilization was performed in 54% of patients in Boston versus none in Utrecht (p&lt;0.001), whereas percutaneous stabilization was performed in 1.3% of patients in Boston versus 39% in Utrecht (p&lt;0.001). In Utrecht, patients received postoperative radiotherapy more frequently (70% <em>vs</em> 54%; p&lt;0.001) and earlier (17 days [IQR:12–24] <em>vs</em> 29 days [IQR:23–39]; p&lt;0.001). Postoperative neurological outcome, complications, reoperation rates, and survival did not differ between the two cohorts (all p&gt;0.05).</div></div><div><h3>Conclusions</h3><div>Differences in patient populations and surgical management exist between tertiary hospitals on separate continents. Further research is needed to determine the optimal extent and timing of surgery to improve quality of life for patients with spinal metastases.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100676"},"PeriodicalIF":3.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-treatment late and long-term effects in bone sarcoma: A scoping review","authors":"Kaainat Khan ,&nbsp;Kathleen Kane ,&nbsp;Zoe Davison ,&nbsp;Darrell Green","doi":"10.1016/j.jbo.2025.100671","DOIUrl":"10.1016/j.jbo.2025.100671","url":null,"abstract":"<div><div>Despite the fact that chemotherapy for bone sarcomas (e.g. Ewing sarcoma, osteosarcoma) has well-reported toxicities and that surgical intervention is frequently life altering, follow-up care to monitor for late and long-term effects beyond that of oncological surveillance in former patients is variable. Anecdotal evidence suggests that inconsistent follow-up means some former bone sarcoma patients are left to cope with post-treatment late and long-term effects with limited support. Here, we performed a scoping review to provide a more empirical identification of the knowledge gaps and to provide an overview of the peer reviewed academic literature reporting the late and long-term effects of treatment for bone sarcoma. JBI Scoping Review Network guidelines for charting, analysis and data extraction were followed. Literature searches were conducted in Medline (Ovid), Cochrane CENTRAL, EMBASE (Ovid), CINAHL, PsycINFO, Proquest and Web of Science (Clarivate Analytics) from March 2024 to September 2024. Paper titles and abstracts were screened by two independent reviewers followed by full text analysis by the lead researcher. Seventy-four peer reviewed articles were included in the analysis. Most studies were of a retrospective study design, some up to 20 years of follow-up and included chemotherapy, surgery and sometimes radiotherapy as the treatment modality. Our analysis identified secondary malignancies, cardio- and nephrotoxicity, lower bone mineral density and microarchitectural deterioration, cancer related fatigue and motor neuropathies as the major physical late and long-term effects requiring dedicated follow-up. In some cases, follow-up may need to span decades, especially given the increasing population of former patients. Our results form the evidence-based foundations for future work that might include late and long-term effect follow-up service mapping exercises and expanded clinical recommendations.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100671"},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel bone metastasis-related gene signature for predicting prognosis, anti-androgen resistance, and drug choice in prostate cancer","authors":"Yu Luo ,&nbsp;Xiaoqi Deng ,&nbsp;Chengcheng Wei ,&nbsp;Zhangcheng Liu ,&nbsp;Liangdong Song ,&nbsp;Kun Han ,&nbsp;Yunfan Li ,&nbsp;Jindong Zhang ,&nbsp;Shuai Su ,&nbsp;Delin Wang","doi":"10.1016/j.jbo.2025.100673","DOIUrl":"10.1016/j.jbo.2025.100673","url":null,"abstract":"<div><h3>Objective</h3><div>Prostate cancer (PCa) often metastasizes to the bone, posing a significant clinical challenge. This study aims to develop a bone metastasis-related risk model for PCa.</div></div><div><h3>Methods</h3><div>Bone metastasis-related genes (BMRGs) were identified through a combination of differential gene expression analysis and WGCNA using GSE32269 and GSE77930 datasets. Consensus clustering analysis was employed to determine the significance of these genes in molecular subtyping of PCa. LASSO-Cox regression analysis was utilized to construct the bone metastasis-related prognostic gene signature (BMRPS). The predictive performance of BMRPS was assessed using ROC curves, Kaplan-Meier survival curves, and a predictive nomogram. The immune landscape heterogeneity of subgroups was analyzed using CIBERSORT, ESTIMATE, and xCell algorithms. Drug sensitivity and molecular docking analysis were performed to identify drugs associated with BMRPS.</div></div><div><h3>Results</h3><div>Forty-four BMRGs associated with the prognosis of PCa were identified. Consensus clustering revealed the pivotal role of these genes in stratifying PCa into three distinct prognostic clusters. The BMRPS, consisting of 14 BMRGs, demonstrated excellent predictive accuracy for prognosis and served as an independent prognostic factor in PCa. BMRPS effectively predicted the overall survival of bone metastatic PCa and differentiated bone metastasis from other metastatic types. BMRPS showed a close correlation with the immune landscape and immunotherapeutic response biomarkers. Additionally, BMRPS was associated with anti-androgen resistance, and AZD8186 was identified as a potential BMRPS-related drug that holds promise for personalized treatment in PCa.</div></div><div><h3>Conclusion</h3><div>BMRPS facilitates the prediction of prognosis and resistance to anti-androgens in PCa. It also offers insights into the molecular mechanisms of bone metastasis and aids in drug selection for the treatment of PCa.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100673"},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Indeterminate pulmonary nodules (IPNs) as independent prognostic indicators in pediatric osteosarcoma: A ten-year retrospective study","authors":"Yao Weitao ,&nbsp;Du Xinhui ,&nbsp;Li Zhehuang ,&nbsp;Hou Jingyu ,&nbsp;Ma Shengbiao ,&nbsp;Zhang Panhong ,&nbsp;Niu Xiaohui","doi":"10.1016/j.jbo.2025.100674","DOIUrl":"10.1016/j.jbo.2025.100674","url":null,"abstract":"<div><h3>Background</h3><div>Osteosarcoma is the most common primary malignant bone tumor in pediatric and adolescent patients. Although pulmonary metastasis is a key driver of prognosis, the role of IPNs in risk stratification remains inadequately defined.</div></div><div><h3>Objective</h3><div>This study aims to assess the incidence, progression, and prognostic significance of IPNs in pediatric and adolescent osteosarcoma patients, providing insights for clinical staging and treatment strategy development.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical data from 126 osteosarcoma patients aged 20 years or younger who were treated at Henan Cancer Hospital between January 2012 and January 2022. Pre-treatment thin-slice computed tomography (CT) scans of lung were used to categorize patients into three groups: no IPN (n = 100), solitary IPN (n = 16), and multiple IPNs (n = 10). Baseline characteristics, primary tumor parameters, treatment modalities, and follow-up data were collected. Univariate and multivariate analyses were conducted to assess risk factors and survival outcomes.</div></div><div><h3>Results</h3><div>The overall incidence of IPNs was 20.6 %, with multiple IPNs accounting for 38.5 % of the IPN-positive cases. A significantly higher proportion of patients in the IPN-positive group had bone involvement exceeding one-third of the total affected bone compared to the no-IPN group (57.7 % vs. 34.0 %, p = 0.016). While univariate analysis suggested a potential association between tumor diameter &gt; 8 cm and IPN occurrence (odds ratio [OR] = 2.08, 95 % confidence interval [CI]: 0.83–5.21, p = 0.120), this was not statistically significant in multivariate analysis (OR = 3.61, p = 0.283). Kaplan–Meier survival analysis revealed that the 3-year metastasis-free survival (MFS) and overall survival (OS) rates in the IPN-positive group were significantly lower than those in the no-IPN group (MFS: 57.7 % vs. 64.0 %, p = 0.03; OS: 65.4 % vs. 76.0 %, p = 0.04). Further subgroup analysis indicated that while solitary IPN cases had survival outcomes comparable to those without IPNs, multiple IPN cases exhibited a markedly reduced 5-year OS (30.0 % vs. 69.0 %, p = 0.045). Cox regression analysis demonstrated that multiple IPNs increased the risk of death by 2.87-fold (hazard ratio [HR] = 2.87, p = 0.020).</div></div><div><h3>Conclusion</h3><div>Indeterminate Pulmonary Nodules are relatively common in pediatric osteosarcoma patients. In particular, multiple IPNs are strongly associated with a higher tumor burden and increased metastatic potential, serving as an independent indicator of poor prognosis. These findings emphasize the importance of preoperative IPN assessment and risk stratification in guiding individualized treatment strategies.</div></div>","PeriodicalId":48806,"journal":{"name":"Journal of Bone Oncology","volume":"52 ","pages":"Article 100674"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}