Clinical significance of indeterminate pulmonary nodules on the survival of 364 patients with nonmetastatic, high‐grade, localized osteosarcoma: A 12‐year retrospective cohort study

Abstract

Background and ObjectivesWe investigated the clinical significance of indeterminate pulmonary nodules (IPNs) in patients diagnosed with nonmetastatic, high‐grade localized osteosarcoma.MethodsWe retrospectively analyzed the clinical data of 364 patients with nonmetastatic, high‐grade localized osteosarcoma. Based on pulmonary computed tomography findings at presentation, the patients were categorized into the no‐nodules and the IPNs group and were further categorized into subgroups based on age (<18 and ≥18 years). We performed an intergroup comparison of event‐free survival (EFS) and overall survival (OS).ResultsAt presentation, 276 (75.8%) patients showed no nodules, and 88 (24.2%) patients showed IPNs. The EFS and OS were similar between adults with IPNs (n = 54 [30.5%]) and without nodules (n = 123 [69.5%]) (p = .200 and p = .609, respectively). No significant intergroup difference in OS was observed in pediatric patients (p = .093). However, pediatric patients with IPNs (n = 34 [18.2%]) had poorer EFS than those without nodules (n = 153 [81.8%]) (p = .016). Multivariate analyses confirmed that IPNs were independently associated with poorer EFS in pediatric patients (hazard ratio 1.788, 95% confidence interval 1.092–2.926, p = .021).ConclusionsThis study showed that IPNs at presentation did not affect the survival of adults with nonmetastatic, high‐grade localized osteosarcoma but were associated with poorer EFS in pediatric patients.

Discovery and Characterization of Intercondylar Transphyseal Complexes and their Oncological Significance in Transphyseal Extension of Pediatric Osteosarcoma

“…Osteosarcoma (OS), the most common primary sarcoma affecting the lower extremities in skeletally immature individuals, has attracted considerable attention in various studies in recent decades 10 , 11 , 12 . Currently, open physes are often regarded as a natural barrier to osteosarcoma invasion because of their high avascularity, continuity, and cell density, and few people expect them to have a “gap” 3 , 13 .…”

Osteosarcoma immune prognostic index can indicate the nature of indeterminate pulmonary nodules and predict the metachronous metastasis in osteosarcoma patients

“…With the application of fine-section computed tomography (CT), more suspicious pulmonary nodules are detected, bringing new challenges for accurate identification of pulmonary metastasis status in osteosarcoma patients (16). Since IPNs are not specific in cancer patients, the identification of their nature is difficult or even not feasible (11,12,16,17). Due to the size of IPNs, needle biopsy is usually not feasible, and as an invasive test, biopsy may be excessive (17,18).…”

“…Since IPNs are not specific in cancer patients, the identification of their nature is difficult or even not feasible (11,12,16,17). Due to the size of IPNs, needle biopsy is usually not feasible, and as an invasive test, biopsy may be excessive (17,18). Clinically, radiologists often estimate the probability of lung metastasis with nodule size, margin, presence of calcification, and nodule amount (19)(20)(21).…”

“…Timely determination of the nature of IPNs and accurate development of individualized treatment decisions could improve the prognosis of osteosarcoma patients (3,11,17). In recent years, researchers have tried to determine the nature of IPNs by cell-free DNA (cfDNA), microRNA (miRNA), and circulating tumor cells (CTCs) (22).…”