骨肉瘤患者肺部性质不确定结节的影像特征和预后分析  

Clinical significance of indeterminate pulmonary nodules in patients with osteosarcoma

作　　者：汪红胜 沈嘉康[1] 昝鹏飞 孙梦熊[1] 左冬青 王崇任 马小军[1] 华莹奇[1] 孙伟[1] WANG Hong-sheng;SHEN Jia-kang;ZAN Peng-fei;SUN Meng-xiong;ZUO Dong-qing;WANG Chong-ren;MA Xiao-jun;HUA Ying-qi;SUN Wei(Department of Orthopaedics,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200030,China)

机构地区：[1]上海交通大学附属第一人民医院骨科、上海市骨肿瘤研究所,200030

出　　处：《中国骨与关节杂志》2021年第11期834-839,共6页Chinese Journal of Bone and Joint

摘　　要：目的分析骨肉瘤患者不确定性质肺结节(indeterminate pulmonary nodules,IPN)的发生率、影像特征以及与临床预后的关系。方法2015年1月至2019年12月,回顾性分析83例未发生肺转移的骨肉瘤患者胸部CT影像特征和临床资料并复习相关文献。结果纳入83例骨肉瘤患者中32例(38.55%)伴有IPN,男21例(65.62%),女11例(34.38%);发病年龄主要集中于18岁以下,共21例(65.62%)。与胸部CT正常的骨肉瘤患者相比较,伴有IPN患者的肺转移率更高(χ^(2)=4.275,P<0.0001);IPN患者的总体生存率(HR,7.541;95%,2.117~26.866;P=0.02)和无事件生存率(HR,3.873;95%,1.870~8.023;P<0.001)显著低于胸部CT正常患者。32例IPN患者中22例(68.75%)发生肺转移,总共记录34个肺部微小结节,CT上显示这些结节特征为椭圆形,边界光滑;多为实性结节,以钙化为主;大部分位于外周,接近胸膜。结论骨肉瘤患者CT影像无法明确性质的肺结节需要密切随访,根据结节的转归调整治疗和随访计划。Objective To analyze the clinical significance of indeterminate pulmonary nodule(IPN)in terms of progression to pulmonary metastasis and its impact on survival.Methods A retrospective study of 83 patients with non-metastatic osteosarcoma were performed from January 2015 to December 2019.Chest CT and clinical features were analyzed.Literatures on IPN were reviewed.Results Of the 83 cases,32 cases(21 males,65.62%;11 females,34.38%;total,38.55%)were found to have IPN in the lung.The age of onset was mainly concentrated under the age of 18,with a total of 21 cases(65.62%).After controlling for potential confounding variables like local control strategy,tumor size,and chemotherapy-induced necrosis,we found that the presence of an IPN was associated with a higher incidence of metastases(χ^(2)=4.275,P<0.0001).The 5-year overall survival(OS)and event-free survival(EFS)for patients with IPN was worse than the patients with no nodules(HR,7.541;95%,2.117-26.866;P=0.02;HR,3.873;95%,1.870-8.023;P<0.001,respectively).Among 32 IPN patients,22 patients(26.5%)were diagnosed as pulmonary metastasis.A total of 34 small lung nodules were recorded.CT showed that these nodules were oval in shape with smooth borders;most of them were solid nodules,mainly calcified;most of them were located in the periphery,close to the pleura.Conclusions IPN is associated with a higher risk of pulmonary metastasis.Treatment and follow-up plan should be adjusted according to the nodule property.

关 键 词：骨肉瘤 肿瘤转移 体层摄影术 螺旋计算机 肺结节 

分 类 号：R738.1[医药卫生—肿瘤]