Pulmonary Metastases In Patients Research Articles

Detection limit of computed tomography for hepatoblastoma pulmonary metastases: Based on total resection using indocyanine green fluorescence

BackgroundIntraoperative search for small pulmonary metastases of hepatoblastoma has been challenging; therefore, it has been difficult to determine the true detection limit of computed tomography (CT). This is the first report on the detection limit of CT for hepatoblastoma pulmonary metastases in patients who underwent resection of hepatoblastoma pulmonary metastases using indocyanine green fluorescence (ICGF). MethodsWe retrospectively reviewed the CT images of patients who underwent resection of hepatoblastoma pulmonary metastases using ICGF between January 2013 and November 2021 at a single children's hospital and compared them with pathological findings. ResultsOverall, 757 nodules were resected from 20 cases and 75 thoracotomies; 411 nodules were considered for the study and 286 were pathologically positive. The number of nodules classified by size in the pathological sections and the probability of CT detection were as follows: < 2 mm: CT-positive/pathology-positive, 43/144, 29.9 %; ≥ 2 and < 3 mm: 5/10, 50 %; ≥ 3 and < 4 mm: 20/27, 74.1 %; ≥ 4 and < 5 mm: 15/16, 93.8 %; ≥ 5 mm: 87/89, 97.8 %. Of 286 pathology-positive nodules, 59.4 % were CT-positive. With a cut-off value of 3 mm for tumor size, the proportion of CT-positive nodules was 92.4 %. Of 177 CT-positive nodules, 170 were pathologically positive. ConclusionsMore than 90 % of nodules > 3 mm were detectable on CT, whereas less than 30 % of pathologically positive nodules < 2 mm could be detected. In children with hepatoblastoma, a CT-positive pulmonary nodule, even if minute, is likely to be malignant and metastasis should be suspected.

Radiomics analysis based on CT for the prediction of pulmonary metastases in ewing sarcoma

ObjectivesThis study aimed to develop and validate radiomics models on the basis of computed tomography (CT) and clinical features for the prediction of pulmonary metastases (MT) in patients with Ewing sarcoma (ES) within 2 years after diagnosis.Materials and methodsA total of 143 patients with a histopathological diagnosis of ES were enrolled in this study (114 in the training cohort and 29 in the validation cohort). The regions of interest (ROIs) were handcrafted along the boundary of each tumor on the CT and CT-enhanced (CTE) images, and radiomic features were extracted. Six different models were built, including three radiomics models (CT, CTE and ComB models) and three clinical-radiomics models (CT_clinical, CTE_clinical and ComB_clinical models). The area under the receiver operating characteristic curve (AUC), and accuracy were calculated to evaluate the different models, and DeLong test was used to compare the AUCs of the models.ResultsAmong the clinical risk factors, the therapeutic method had significant differences between the MT and non-MT groups (P＜0.01). The six models performed well in predicting pulmonary metastases in patients with ES, and the ComB model (AUC: 0.866/0.852 in training/validation cohort) achieved the highest AUC among the six models. However, no statistically significant difference was observed between the AUC of the models.ConclusionsIn patients with ES, clinical-radiomics model created using radiomics signature and clinical features provided favorable ability and accuracy for pulmonary metastases prediction.

Development and validation of a nomogram for risk of pulmonary metastasis in non-papillary thyroid carcinoma: A SEER-based study.

In this study, a nomogram was established and validated by assessing the risk factors for the development of pulmonary metastases in patients with non-papillary thyroid carcinoma (NPTC) and was used to predict the risk of developing pulmonary metastases. Demographic and clinicopathological variables of patients with NPTC from 2010 to 2015 in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed, and independent risk factors were identified using χ2 tests and full subset regression analysis. Based on this, a nomogram was developed and validated for predicting the risk of pulmonary metastasis in patients with NPTC. The predictive performance of the nomogram was calculated using the consistency index, and the clinical application value of the nomogram was evaluated using calibration curve and decision curve analyses. In addition, risk stratification of patients with NPTC based on these results was performed to facilitate early diagnosis and treatment of patients with pulmonary metastases in the clinic. Data from 1435 patients with NPTC were used for the analysis based on the inclusion and exclusion criteria. Statistical analysis yielded a high risk of pulmonary metastasis in patients with older age, high T-stage, poorly differentiated, undifferentiated thyroid carcinoma, follicular thyroid carcinoma (NOS), and the presence of other distant metastases. We further developed a nomogram with a consistency index of 0.898 (95% confidence interval: 0.880-0.920) in the training cohort and 0.895 (95% confidence interval: 0.862-0.927) in the validation cohort. The calibration curve and decision curve analyses also demonstrated the strong reliability and accuracy of this clinical prediction model. In this study, a nomogram was constructed to accurately identify patients with NPTC at a high risk of pulmonary metastasis, which will help clinicians in personalized decision-making.

AOST2031: An in-progress COG phase 3 randomized controlled trial comparing open vs thoracoscopic management of pulmonary metastases in patients with osteosarcoma.

TPS11579 Background: Pulmonary metastasectomy is considered a necessary component of curative therapy in pulmonary metastatic osteosarcoma, however the optimal surgical approach is unknown. Two approaches include open surgery (OSY) including thoracotomy or sternotomy and minimally invasive surgery (MSY) by thoracoscopy. No randomized trial has been completed comparing these approaches in patients with osteosarcoma, however randomized controlled trials in other cancers have not identified superior outcomes in patients undergoing OSY. OSY allows for direct palpation of all lung surfaces and more pulmonary metastatic nodules can be identified during OSY compared to the number predicted by pre-operative imaging. MSY offers the benefit of faster patient recovery, improved quality of life and potential for equivalent surgical control of relevant metastatic disease. Given wide variability in surgical approach and willingness of both surgical oncology and patient advocacy communities to participate in a randomized trial, AOST2031 was developed to address this clinical equipoise. Methods: Eligibility for AOST2031 includes patients &lt; 50 yrs with a histological diagnosis of osteosarcoma and evidence of pulmonary metastases at initial diagnosis or at first recurrence. Patients must have oligometastatic lung metastasis considered resectable by either OSY or MSY, with rapid central review of chest CT images to confirm eligibility. Systemic therapy considered equivalent to methotrexate, cisplatin and doxorubicin is required to be ongoing in newly diagnosed and completed in patients with recurrence. Exclusion criteria include unresectable primary disease, metastatic disease requiring anatomic lung resection, pleural or mediastinal lesions or pleural effusions, progression while receiving initial therapy, extra-pulmonary metastases and prior chest surgery for pulmonary metastases. Patients are randomized 1:1 to either OSY or MSY, with randomization stratified by disease status and risk. The primary outcome is thoracic event free survival, defined as intrathoracic tumor recurrence or death that results from the procedure or a complication related to the procedure. Two-hundred and twenty-five eligible patients are anticipated to answer the primary objective. Secondary objectives include event free, overall survival and . Exploratory objectives include surgical complication rates, patterns of recurrence, use of surgical localization techniques, comparison of CT findings to pathology of resected specimens, and patient reported outcomes. Biologic objectives include the collection of metastatic tissues to facilitate the study of metastatic disease and serial blood samples for future tumor profiling, germline and circulating tumor DNA studies. AOST2031 opened to enrollment at NCTN sites in February 2022. Clinical trial information: NCT05235165 .

Pulmonary metastasectomy and repeat metastasectomy for colorectal pulmonary metastases: outcomes from the Dutch Lung Cancer Audit for Surgery

Surgical resection of recurrent pulmonary metastases in patients with colorectal cancer is an established treatment option; however, the evidence for repeat resection is limited. The aim of this study was to analyse long-term outcomes from the Dutch Lung Cancer Audit for Surgery. Data from the mandatory Dutch Lung Cancer Audit for Surgery were used to analyse all patients after metastasectomy or repeat metastasectomy for colorectal pulmonary metastases from January 2012 to December 2019 in the Netherlands. Kaplan-Meier survival analysis was performed to determine the difference in survival. Multivariable Cox regression analyses were performed to identify predictors of survival. A total of 1237 patients met the inclusion criteria, of which 127 patients underwent repeat metastasectomy. Five-year overall survival was 53 per cent after pulmonary metastasectomy for colorectal pulmonary metastases and 52 per cent after repeat metastasectomy (P = 0.852). The median follow-up was 42 (range 0-285) months. More patients experienced postoperative complications after repeat metastasectomy compared with the first metastasectomy (18.1 per cent versus 11.6 per cent respectively; P = 0.033). Eastern Cooperative Oncology Group performance status greater than or equal to 1 (HR 1.33, 95 per cent c.i. 1.08 to 1.65; P = 0.008), multiple metastases (HR 1.30, 95 per cent c.i. 1.01 to 1.67; P = 0.038), and bilateral metastases (HR 1.50, 95 per cent c.i. 1.01 to 2.22; P = 0.045) were prognostic factors on multivariable analysis for pulmonary metastasectomy. Diffusing capacity of the lungs for carbon monoxide less than 80 per cent (HR 1.04, 95 per cent c.i. 1.01 to 1.06; P = 0.004) was the only prognostic factor on multivariable analysis for repeat metastasectomy. This study demonstrates that patients with colorectal pulmonary metastases have comparable median and 5-year overall survival rates after primary or recurrent pulmonary metastasectomy. However, repeat metastasectomy has a higher risk of postoperative complications.

Venous Thromboembolic Event Following Soft Tissue Sarcoma Diagnosis is Associated with the Development of Pulmonary Metastasis.

This study aimed to investigate whether venous thromboembolic events (VTEs) are clinically relevant predictors of pulmonary metastatic disease in patients with soft tissue sarcomas (STSs). In this retrospective cohort analysis, we included patients with STS surgically treated for sarcoma between January 2002 and January 2020. The primary outcome of interest was development of pulmonary metastasis after non-metastatic STS diagnosis. Tumor depth, stage, type of surgical intervention, chemotherapy, radiation therapy, body mass index, and smoking status were collected. Episodes of VTEs following STS diagnosis, including deep vein thrombosis, pulmonary embolism, and other thromboembolic events, were also obtained. Univariate analyses and multivariable logistic regression were used to identify potential predictors for pulmonary metastasis. We included 319 patients with mean age of 54.9±16 years. Thirty-seven patients (11.6%) had VTE after STS diagnosis, and 54 (16.9%) developed pulmonary metastasis. Univariate screening revealed pulmonary metastasis, pre- and postoperative chemotherapy, smoking history, and VTE after surgery as potential predictors of pulmonary metastasis. Multivariable logistic regression revealed smoking history [odds ratio (OR) 2.0, confidence interval (CI) 1.1-3.9, P=0.04] and VTE (OR 6.3, CI 2.9-13.6, P<0.001) as independent risk factors for predicting pulmonary metastasis in patients with STS, after adjusting for the factors in the univariate screening as well as age, sex, stage of the tumor, and neurovascular invasion. Patients with VTE after STS diagnosis have an odds ratio of 6.3 for developing metastatic pulmonary disease compared with patients without venous thromboembolic events. Smoking history was also associated with future pulmonary metastases.

Lymph Node Ratio Is Associated with Time to Pulmonary Metastasis in Patients with Resected Colorectal Cancer

INTRODUCTION: Despite curative resection for colorectal cancer (CRC), pulmonary metastasis (PM) may occur in up to 18% of cases. Among biomarkers that have been previously explored to inform CRC prognosis, Lymph Node Ratio (LNR) has been associated with shorter overall and disease-free survival in patients with resectable disease. We sought to investigate LNR from primary CRC pathology as a risk factor for overall development as well as time to development of PM. METHODS: A retrospective analysis of patients from prospectively maintained institutional thoracic and colorectal surgical databases (2000-2017) was performed. Patients were categorized based on whether they developed PM. LNR was defined as ratio of malignant nodes to total nodes harvested during primary colorectal resection. Multivariable Cox regression analysis (MVA) was performed to investigate the effect of LNR on time to PM diagnosis. RESULTS: 1600 patients were included in the analysis, among whom 233 (14.6%) were diagnosed with PM during follow-up. Patients without PM had median LNR of 0.00 (interquartile range [IQR]: 0.00 to 0.07), while patients who were diagnosed with PM had median LNR of 0.06 (IQR: 0.00 to 0.18). MVA controlling for clinicopathologic variables (Table) revealed LNR to predict time to PM diagnosis in CRC patients (hazard ratio: 14.93, 95% confidence interval: 6.13 to 36.37, p < 0.001). CONCLUSION: Elevated LNR is associated with both diagnosis and time to development of PM in patients with resectable CRC. As such, LNR should be considered during discussions of prognosis and recommendations for surveillance after primary CRC resection. Table. - Multivariable Cox Regression Analysis Investigating the Effect of Lymph Node Ratio on Pulmonary Metastasis development Clinicopathologic characteristics Hazard ratio (95% CI) p Value Lymph Node Ratio (Increasing) 14.93 (6.13-36.37) <0.001 Neoadjuvant Chemotherapy 1.44 (1.06-1.95) 0.020 Pathologic T Status >2 1.59 (1.05-2.38) 0.027 CRC Location Right Reference Left 1.74 (1.18-2.56) 0.005 Rectum 0.91 (0.58-1.43) 0.683 KRAS Mutated 5.62 (4.12-7.65) <0.001 Adjuvant Chemotherapy 5.68 (3.87-8.34) <0.001

PET-Uptake in Liver Metastases as Method to Predict Tumor Biological Behavior in Patients Transplanted for Colorectal Liver Metastases Developing Lung Recurrence.

Simple SummaryMany colorectal cancer patients with liver-only metastases receiving liver transplantation develop pulmonary metastases after liver transplantation. Pre-transplant PET liver uptake determines overall survival in patients treated by post-transplant resection of pulmonary metastases.The objective of the study was to determine the impact of PET uptake on liver metastases on overall survival (OS) after resection of pulmonary metastases in patients who had received liver transplantation (LT) due to unresectable colorectal liver-only metastases. Resection of pulmonary colorectal metastases is controversial. Some hospitals offer this treatment to selected patients, whereas other hospitals do not perform the procedure in colorectal cancer patients who develop pulmonary metastases. All patients included in the LT studies who developed pulmonary metastases as first site of relapse, and had resection of these as first treatment, were included in this report. Metabolic tumor volume (MTV) in liver was derived from the pre-transplant PET examinations. OS from time of resection was calculated by the Kaplan–Meier method. Patients with low MTV (<70 cm3) had significantly longer OS from time of resection of pulmonary metastases compared to patients with high MTV (>70 cm3). Patients with low MTV in the liver had 10-year OS from time of pulmonary resections of 86%. Liver MTV values from pre-transplant PET examinations may predict long OS in colorectal cancer patients with a resection of pulmonary metastases developing after LT. Thus, in selected colorectal cancer patients developing pulmonary metastases resection of these metastases should be the treatment of choice.

Preoperative PDW levels predict pulmonary metastasis in patients with hepatocellular carcinoma

BackgroundIn hepatocellular carcinoma (HCC), pulmonary metastasis (PM) after hepatectomy is associated with poor clinical outcomes. The crucial phases of tumour cell proliferation, angiogenesis, and metastasis all entail platelet activation. In HCC, platelet distribution width (PDW) suggests platelet size changes and predicts a worse prognosis. The aim of this study was to assess the association between PDW and PMs in HCC patients receiving hepatectomy.Material/methodsFrom January 2013 to December 2015, a cohort of patients who underwent hepatectomy for HCC at the Harbin Medical University Cancer Hospital in China were retrospectively evaluated. The relationship between PDW levels and clinical and demographic parameters was examined. To investigate the relationships between predicted factors and PM, a competing risk model was used. From January 2016 to December 2018, a validation cohort of 109 patients from the First Affiliated Hospital of Harbin Medical University was studied independently.ResultsIn the primary cohort, 19 out of 214 patients had postoperative PMs. In HCC patients with PM, PDW levels were lower than in those without PM. There was a significant difference in the cumulative incidence of 2-year PM between the high-PDW and low-PDW groups after controlling for competing risk events (death prior to the development of PM) (p < 0.001). In addition, PDW was also found to be an independent predictor for PM in a multivariable competing risk analysis. The results were externally validated in another cohort.ConclusionsIn HCC, preoperative PDW is significantly associated with PM. PDW could be a biomarker for post-operative PM in HCC patients.

Volume Doubling Times of Pulmonary Metastases in Patients With Bone and Soft-Tissue Sarcomas: Associations With Subsequent New Metastases and Survival After Metastasectomy.

BACKGROUND. Pulmonary metastases of bone and soft-tissue sarcoma are common and have a high recurrence rate after metastasectomy. Factors associated with postmetastasectomy recurrence are not well studied. OBJECTIVE. The purpose of this study was to investigate the association of the volume doubling time (VDT) of pulmonary metastases with the subsequent development of new pulmonary nodules and survival after metastasectomy in patients with bone or soft-tissue sarcoma. METHODS. This retrospective study included patients with bone or soft-tissue sarcoma who, between January 2010 and December 2020, underwent first complete metastasectomy of pulmonary nodules visualized on two sequential preoperative CT scans. Semiautomatic volumetric segmentation of the pulmonary metastases was performed on the two CT scans, and VDTs were calculated. VDT was compared between patients with and without subsequent new metastases after metastasectomy. Cox proportional hazards regression analyses were performed to determine risk factors for recurrence-free survival (RFS) after metastasectomy and for postmetastasectomy overall survival (OS). RESULTS. Forty patients (21 women, 19 men; mean age, 51.1 ± 14.3 [SD] years) were included. Of these patients, 23 (57.5%) developed new metastatic nodules after metastasectomy, and 10 (25.0%) died during follow-up. Median VDT was shorter in patients with, versus those without, new metastases after metastasectomy (56 vs 140 days, p = .002). Only four of 23 patients with new metastases had VDT of 140 days or more. In multivariable analysis, older age (hazard ratio [HR], 1.06; p = .004), female sex (HR, 2.80; p = .03), and VDT less than 140 days (HR, 4.22; p = .01) were independent predictors of worse RFS. Also in multivariable analysis, only older age (HR, 1.17; p = .005) and VDT less than 50 days (HR, 8.60; p = .02) were independent predictors of worse OS. OS was significantly worse in patients with VDT less than 140 days (10 deaths among 27 patients) than in patients with VDT of 140 days or more (no deaths in 13 patients) (p = .01). CONCLUSION. In patients with bone and soft-tissue sarcoma, shorter VDT of pulmonary metastases is independently associated with subsequent new metastases after metastasectomy and worse OS. CLINICAL IMPACT. VDT of pulmonary nodules may be considered in patient selection for pulmonary metastasectomy and in postoperative patient management.

Downregulation of the Proton-Activated Cl- Channel TMEM206 Inhibits Malignant Properties of Human Osteosarcoma Cells.

Transmembrane protein 206 (TMEM206), a proton-activated chloride channel, has been implicated in various biochemical processes, including bone metabolism, and has emerged as a novel cancer-related protein in multiple tumor types. However, its role in primary malignant bone tumors, particularly in osteosarcoma (OS), remains unclear. This study is aimed at exploring the effects of TMEM206 gene silencing on the proliferation, migration, invasion, and metastasis of human OS cells in vitro and in vivo using an shRNA-knockdown strategy. We found that TMEM206 is frequently overexpressed and that high levels of TMEM206 correlated with clinical stage and pulmonary metastasis in patients with OS. We provided evidence that TMEM206-silenced OS cancer cells exhibit decreased proliferation, migration, and invasion in vitro. Mechanistically, we identified β-catenin, a key member of Wnt/β-catenin signaling, as a downstream effector of TMEM206. TMEM206 silencing inhibits the Wnt/β-catenin signaling pathway in expression rescue experiments, confirming that TMEM206 silencing attenuates OS cell tumorigenic behavior, at least in part, via the β-catenin mediated downregulation of Wnt/β-catenin signaling. More importantly, TMEM206 knockdown-related phenotype changes were replicated in a xenograft nude mouse model where pulmonary metastases of OS cells were suppressed. Together, our results demonstrate that silencing TMEM206 negatively modulates the Wnt/β-catenin signaling pathway via β-catenin to suppress proliferation, migration, invasion, and metastasis in OS carcinogenesis, suggesting TMEM206 as a potential oncogenic biomarker and a potential target for OS treatment.

CT Findings of Pulmonary Metastases from Primary Cardiac Angiosarcoma.

Primary cardiac angiosarcoma is a rare malignancy with high predilection to involve surrounding structures such as pulmonary metastases. We analysed the chest computed tomography (CT) imaging features of patients diagnosed with primary cardiac angiosarcoma with pulmonary metastases in this study. This study retrospectively reviewed 12 patients with confirmed primary cardiac angiosarcoma, out of which eight (all men) with pulmonary metastasis were included in the analysis. The patients' age ranged from 17 to 74 (mean: 48) years. CT was performed in all patients with unenhanced, contrast-enhanced, and both scans were done in 1, 3 and 4 patients, respectively. Nodular lesions were observed in 7 patients with multiple solid nodules observed in 6 out of 7 patients. A solitary solid nodule was found in the remaining patient in the upper lobe and apical segment of the right lung with a diameter of 11.7 mm. All solid nodules were distributed along with bronchovascular bundles in the lungs, and their maximum diameter ranged from 2.3 to 19.9 mm. Nodules larger than 10 mm in diameter were heterogeneously enhanced on contrast-enhanced CT images (5/8 patients), whereas those smaller than 10 mm were homogeneously enhanced (3/8 patients). Other imaging features, namely the tree-in-bud pattern, emphysema, pleural effusion, and mediastinal lymph node enlargement, were observed in 4, 3, 3, and 2 patients, respectively. CT enhancement features of pulmonary metastasis in patients with primary cardiac angiosarcoma depend on the size of pulmonary nodules, with larger ones being heterogeneous and smaller ones homogeneous. Other signs are less noticed.

Risk factors and oncological outcomes of pulmonary metastasis in patients with giant cell tumor of bone

BackgroundGiant cell tumor (GCT) of bone has a rare potential for metastatic spread. This study aimed at evaluating the incidence of chest metastases in GCT and their oncological outcome and identifying possible risk factors. MethodsMedical records of 466 (313 de novo and 153 recurrent) patients with primary GCT of bone were retrospectively reviewed. Fifteen (3.2%) patients developed chest metastasis. Time from diagnosis of the primary bone lesion to the diagnosis of metastasis, treatment modalities of metastasis, and the course of treatment were revised. The functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system, and postoperative complications were recorded. ResultsThis study included 7 males and 8 females with a mean age of 27.3 ± 7.9 years. The most common site of the primary tumor was the distal femur. All fifteen patients were recurrent cases. The mean follow-up period was 67.7 ± 33.2 months. Chest metastasis was diagnosed after a mean time of 28.1 ± 28.9 months from the initial diagnosis of the bone lesion. One patient died of disease (DOD) 18 months after the surgical intervention. The incidence of chest metastasis in recurrent cases was 9.8%, while de novo cases did not develop chest metastasis, P < 0.001. Previous curettage was associated with a higher incidence of chest metastasis (14.6%) compared to previous resection (4.2%), P = 0.03. ConclusionsChest metastasis following GCT of bone is rare. Risk factors include recurrent cases, especially following previous curettage. Patients have a good prognosis and a low mortality rate. Level of evidenceLevel IV, retrospective.

Machine learning-based CT radiomics features for the prediction of pulmonary metastasis in osteosarcoma.

This study aims to build machine learning-based CT radiomic features to predict patients developing metastasis after osteosarcoma diagnosis. This retrospective study has included 81 patients with a histopathological diagnosis of osteosarcoma. The entire dataset was divided randomly into training (60%) and test sets (40%). A data augmentation technique for the minority class was performed in the training set, along with feature's selection and model's training. The radiomic features were extracted from CT's image of the local osteosarcoma. Three frequently used machine learning models tried to predict patients with lung metastases (MT) and those without lung metastases (non-MT). According to the higher area under the curve (AUC), the best classifier was chosen and applied in the testing set with unseen data to provide an unbiased evaluation of the final model. The best classifier for predicting MT and non-MT groups used a Random Forest algorithm. The AUC and accuracy results of the test set were bulky (accuracy of 73% [ 95% coefficient interval (CI): 54%; 87%] and AUC of 0.79 [95% CI: 0.62; 0.96]). Features that fitted the model (radiomics signature) derived from Laplacian of Gaussian and wavelet filters. Machine learning-based CT radiomics approach can provide a non-invasive method with a fair predictive accuracy of the risk of developing pulmonary metastasis in osteosarcoma patients. Models based on CT radiomic analysis help assess the risk of developing pulmonary metastases in patients with osteosarcoma, allowing further studies for those with a worse prognosis.

Identification, by 99mTc-HDP-SPECT/CT imaging, of unknown pulmonary metastases in patients with osteosarcoma

Identification, by 99mTc-HDP-SPECT/CT imaging, of unknown pulmonary metastases in patients with osteosarcoma

Low incidence of pulmonary metastases in vulvar cancer patients: limited value of routine chest imaging based on a cohort study.

ObjectiveTo evaluate the incidence of pulmonary metastases in the preoperative work‐up of patients with primary vulvar squamous cell carcinoma (SCC).DesignRetrospective cohort study.SettingTertiary referral centre.PopulationPatients treated for primary vulvar SCC from 2000 to 2018.MethodsThe pre‐operative chest imaging of 452 consecutively treated patients was documented with a minimal follow‐up period of 2 years.Mean outcome measuresIncidence of pulmonary metastases, frequency of chest imaging and subsequent coincidental findings.ResultsIn total, 80.8% of patients underwent pre‐operative chest imaging. Seven patients (1.9%), with a median tumour size of 80 mm, presented with pulmonary metastases. None of the patients with early stage disease and tumour size <40 mm who underwent radical local excision (RLE) with sentinel node (SN)‐procedure, was diagnosed with pulmonary metastasis. Chest imaging was performed by radiography (58.9%) and computerised tomography (CT) (41.1%). Coincidental findings were reported in 40.7% of patients who underwent CT, compared with 15.8% of patients undergoing radiography, resulting in additional diagnostics in 14.7 and 19.7% and being of limited consequence for outcome in 2.9 and 3.3%, respectively.ConclusionsThe incidence of pulmonary metastases in patients with primary vulvar SCC is extremely low, and none in patients with early stage disease undergoing the SN procedure. Chest imaging was performed in the majority of patients and was associated with frequent coincidental findings leading to clinically irrelevant diagnostic procedures. Therefore, we recommend omitting chest imaging in patients with early stage disease and tumours <40 mm, considering chest CT only in patients with large tumours and/or advanced stage disease.Tweetable abstractThe incidence of pulmonary metastases is 1.9%, none in early stage disease planned for SN. Omitting chest imaging in this group is advised.

Survival after pulmonary metastasectomy for relapsed osteosarcoma

ObjectivesThe purpose of this study was to evaluate the postrelapse survival of relapsed osteosarcoma with pulmonary metastases in patients who received pulmonary metastasectomy using intent to treat and propensity score analysis. MethodsPatients with osteosarcoma who relapsed with pulmonary metastases between 2004 and 2018 who were treated in a hospital affiliated with a medical school were included. All the enrolled patients were evaluated as operable with assessment algorithm at the time of diagnosis of pulmonary relapse and intent to treat analysis was done. Multiple propensity score methods (eg, matching, stratification, covariate adjustment, and inverse probability of treatment weighting) were performed to balance confounding bias. Cox proportional hazards regression and the Kaplan-Meier method were used to evaluate patient survival. ResultsA total of 125 patients met the study criteria. Of these, 59 (47.2%) patients received pulmonary metastasectomy combined with chemotherapy and 66 (52.8%) received chemotherapy alone. The 2-year and 5-year postrelapse survival rate of metastasectomy group and nonmetastasectomy group were 68.4% versus 25.0% and 41.0% versus 0%, respectively. The median postrelapse survival was 24.9 versus 13.5 months, respectively. Pulmonary metastasectomy was independently associated with improved survival (hazard ratio, 0.185; 95% confidence interval, 0.103-0.330; P < .001). These results were confirmed by multiple propensity score analyses. Further stratified analysis revealed that the survival advantage associated with metastasectomy was not significant in patients with metastases involving ≥3 lung lobes and patients with very high pretreatment serum alkaline phosphatase (more than twice the upper limit). ConclusionsPulmonary metastasectomy is associated with improved survival in patients with recurrent osteosarcoma.

Effects of Anesthetic Technique on Postoperative Pulmonary Metastasis in Patients Undergoing Laryngectomy.

BackgroundWhether laryngeal cancer is directly implanted into the lungs during orotracheal intubation is still unclear. Therefore, this study aimed to find whether orotracheal intubation is an independent risk factor for postoperative pulmonary metastasis in patients undergoing laryngectomy.Patients and MethodsMedical records from January 1, 2006, to December 31, 2016, were reviewed. According to similar propensity scores, patients who received orotracheal intubation (tracheal intubation group, n = 515) were matched 1:1 with those who received tracheotomy (tracheotomy group, n = 326) in the induction of general anesthesia. The primary outcome was postoperative pulmonary metastasis. Secondary outcomes included local recurrence, lymphatic metastasis, tracheostomal recurrence and overall survival.ResultsBetween the two groups, there was no significant difference in postoperative pulmonary metastasis (P = 0.688), local recurrence (P = 0.215), lymphatic metastasis (P = 0.480), tracheostomal recurrence (P = 0.246) or all-cause death (P = 0.299). The primary site of cancer was an independent risk factor for pulmonary metastasis [HR 0.29, 95% CI 0.13–0.68; P = 0.013] and local recurrence (HR 2.69, 95% CI 1.39–5.21; P = 0.003). Type of surgery (HR 3.13, 95% CI 2.03–4.84; P < 0.001) and N classification of TNM (HR 0.27, 95% CI 0.10–0.75; P = 0.012) were risk factors for local recurrence. Postoperative chemotherapy was an independent risk factor for lung metastasis (HR 7.58, 95% CI 3.11–18.47; P < 0.001) and lymphatic metastasis (HR 5.18, 95% CI 2.57–11.91; P < 0.001), and 5-year overall survival was associated with age (P = 0.028), clinical stage (P < 0.001) and postoperative chemotherapy (P = 0.003) but not with anesthetic technique (P = 0.473).ConclusionThis retrospective study suggests that orotracheal intubation in laryngectomy is not a risk factor for postoperative pulmonary metastasis, local recurrence, lymphatic metastasis or overall survival.

P-304 Effectiveness and safety of thermal ablation of pulmonary metastases in patients with colorectal cancer

Pulmonary oligometastatic disease in colorectal cancer can be managed with either resection or ablation. Radiologically guided thermal ablation procedures have the benefit of disease control, preservation of adjacent normal tissue and improved quality of life, based on a short hospital admission and recovery time. We sought to report the effectiveness and safety of radiofrequency and microwave ablation for pulmonary metastases in patients with colorectal cancer.

Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma.

Soft tissue sarcomas (STSs) are rare heterogeneous malignancies of mesenchymal origin. Pulmonary metastases develop in approximately 50% of the patients with high-grade STS, being the major cause of mortality in patients with metastatic STS. Pulmonary metastasectomy has been reported to contribute to long-term survival; however, an appropriate treatment has not been established. We aimed to identify factors associated with post-metastasis survival in STS patients with pulmonary metastasis and determine the appropriate treatment for each patient. We retrospectively reviewed the records of metastatic STS patients treated between 2000 and 2017 and analyzed the clinico-pathologic variables to identify factors associated with the survival. The median survival after pulmonary metastasis was 20.6months, and the 1-, 3-, and 5-year survival rates were 68.6%, 36.0%, and 25.1%, respectively. The survival was significantly greater in patients who underwent pulmonary metastasectomy than in those without surgery (38.9months vs. 10.5months; p < 0.0001). Among those who did not undergo surgery, the survival was significantly greater in patients who received chemotherapy than in those without chemotherapy (19.1months vs. 6.3months, p = 0.037). Multivariate analysis identified pulmonary metastasectomy as the most important prognostic factor for post-metastasis survival (Hazard ratio 5.623; 95% Confidence Interval 2.733-11.572; p < 0.0001). In conclusion, pulmonary metastasectomy was the most important prognostic factor for post-metastasis survival in patients with metastatic STS. In addition, chemotherapy could prolong survival in patients who were not eligible for pulmonary resection. Although we should carefully weigh the risks and benefits, appropriate treatment for pulmonary metastases could contribute to long-time survival.