多个不确定肺结节（ipn）作为儿童骨肉瘤的独立预后指标：一项十年回顾性研究

IF 3.4 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-03-19 DOI:10.1016/j.jbo.2025.100674

Yao Weitao , Du Xinhui , Li Zhehuang , Hou Jingyu , Ma Shengbiao , Zhang Panhong , Niu Xiaohui

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引用次数: 0

摘要

背景：骨肉瘤是儿童和青少年患者中最常见的原发性恶性骨肿瘤。虽然肺转移是预后的关键驱动因素，但ipn在风险分层中的作用仍未充分界定。目的探讨小儿和青少年骨肉瘤患者IPNs的发病率、进展及预后意义，为临床分期和治疗策略制定提供依据。方法回顾性分析2012年1月至2022年1月在河南省肿瘤医院收治的126例20岁及以下骨肉瘤患者的临床资料。使用治疗前肺部薄层计算机断层扫描（CT）将患者分为三组：无IPN (n = 100)，单发IPN （n = 16）和多发IPN （n = 10）。收集基线特征、原发肿瘤参数、治疗方式和随访数据。进行单因素和多因素分析以评估危险因素和生存结果。结果ipn总发病率为20.6%，多发ipn占ipn阳性病例的38.5%。与无ipn组相比，ipn阳性组患者骨受累超过总受影响骨的三分之一的比例明显更高（57.7%比34.0%,p = 0.016）。单因素分析显示肿瘤直径与gt之间存在潜在关联；8 cm与IPN的发生（优势比[OR] = 2.08, 95%可信区间[CI]: 0.83-5.21, p = 0.120），多因素分析中差异无统计学意义（OR = 3.61, p = 0.283）。Kaplan-Meier生存分析显示，ipn阳性组的3年无转移生存率（MFS）和总生存率（OS）明显低于无ipn组(MFS: 57.7% vs. 64.0%, p = 0.03；OS: 65.4% vs. 76.0%, p = 0.04)。进一步的亚组分析表明，虽然单发IPN患者的生存结果与无IPN患者相当，但多发性IPN患者的5年OS明显降低（30.0% vs 69.0%, p = 0.045）。Cox回归分析显示，多重IPNs使死亡风险增加2.87倍（危险比[HR] = 2.87, p = 0.020）。结论不确定肺结节在小儿骨肉瘤中较为常见。特别是，多发ipn与更高的肿瘤负担和转移潜力增加密切相关，可作为预后不良的独立指标。这些发现强调了术前IPN评估和风险分层在指导个体化治疗策略中的重要性。

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Multiple Indeterminate pulmonary nodules (IPNs) as independent prognostic indicators in pediatric osteosarcoma: A ten-year retrospective study

Background

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.

Objective

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.

Methods

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.

Results

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 > 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).

Conclusion

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.

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.