Key result
Baseline indeterminate pulmonary nodules in pediatric osteosarcoma are linked to ~60% higher pulmonary metastasis risk.
Why the study?
Computed tomography frequently detects indeterminate pulmonary nodules in osteosarcoma, but their clinical significance regarding progression to pulmonary metastasis and impact on survival was uncertain.
Does the presence of indeterminate pulmonary nodules increase the risk of pulmonary metastasis in pediatric nonmetastatic osteosarcoma patients?
Cohort (n=155)
Does the presence of indeterminate pulmonary nodules increase the risk of pulmonary metastasis in pediatric nonmetastatic osteosarcoma patients?
Relative Risk: 1.6 (95% CI 1.03–2.5)
Absolute Event Rate: 43% vs 26%
p-value: p=<0.001
Indeterminate pulmonary nodules on baseline CT in pediatric osteosarcoma patients are associated with a significantly increased risk of developing pulmonary metastasis.
IPN presence was associated with higher metastasis risk; leaves open whether it should alter staging or surveillance in nonmetastatic osteosarcoma.
Osteosarcoma is the most common primary malignant bone tumor in children. In addition to pulmonary metastasis, computed tomography frequently detects indeterminate pulmonary nodules (IPN). We conducted this study to determine the clinical significance of IPN in terms of progression to pulmonary metastasis and its impact on survival. It was a retrospective cohort study of pediatric nonmetastatic osteosarcoma patients treated from January 2005 to December 2018. Baseline computed tomography scans were reviewed for the presence of IPN (defined as a single nodule of <10 mm or ≥3 nodules of <5 mm). Subsequent scans were reviewed for the development of pulmonary metastasis. Of 155 patients, 31.6% (n=49) had IPN at baseline. A total of 43% (n=21) of those with IPN subsequently progressed to pulmonary metastasis compared with only 26% (n=28) of those without IPN (P<0.001) with a relative risk of 1.6 (1.03 to 2.5) in the IPN group. Patients with ≥3 IPN at baseline were at significantly greater risk of pulmonary metastasis as compared with <3 IPN (P=0.013). Overall and event-free survival in patients with and without IPN was 58% and 35%, and 72% and 46%, respectively. Our results suggest that patients with IPN may be at greater risk for progressing to pulmonary metastasis.
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Seher et al. (2021) conducted a cohort in Pediatric nonmetastatic osteosarcoma (n=155). Indeterminate pulmonary nodules (IPN) vs. No indeterminate pulmonary nodules was evaluated on Progression to pulmonary metastasis (RR 1.6, 95% CI 1.03 to 2.5, p=<0.001). Baseline indeterminate pulmonary nodules in pediatric osteosarcoma increased the risk of progression to pulmonary metastasis compared to no nodules (43% vs 26%; RR 1.6; 95% CI 1.03-2.5; P<0.001).
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