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Indeterminate pulmonary nodules in patients with sarcoma affect survival
Stacy Rissing1, Bruce T Rougraff, Kenneth Davis
1Department of Radiology, Indiana University Hospital, Indianapolis, IN, USA.
Clinical Orthopaedics and Related Research
|April 18, 2007
Summary
Small indeterminate pulmonary nodules (>=5 mm) in sarcoma patients indicate a higher risk of metastatic disease and worse survival. These findings suggest a need for revised staging and closer patient monitoring.
Area of Science:
- Radiology
- Oncology
- Pulmonary Medicine
Background:
- Pulmonary nodules are common findings in cancer patients.
- The prognostic significance of small, indeterminate pulmonary nodules in sarcoma is not well-defined.
Purpose of the Study:
- To investigate the prognostic value of indeterminate pulmonary nodules detected via computed tomography (CT) in sarcoma patients.
- To determine if nodule size influences disease progression and survival outcomes.
Main Methods:
- Prospective study of 331 sarcoma patients treated between April 1999 and December 2004.
- Initial spiral computed tomography (CT) scans were used to identify and characterize pulmonary nodules.
- Patients were monitored for disease progression and survival.
Main Results:
- Seventy-one patients (21%) presented with indeterminate pulmonary nodules.
- Nodules >=5 mm were associated with significantly worse 3-year disease-free survival (49%) compared to patients with no nodules or tiny nodules (<5 mm) (81%).
- Patients with nodules >=5 mm had better survival than those with definite metastatic disease at presentation (49% vs 5%).
Conclusions:
- Indeterminate pulmonary nodules >=5 mm in sarcoma patients are a significant prognostic factor.
- These patients represent an intermediate risk group between those with normal scans and those with established metastatic disease.
- Consideration of a new staging system and careful follow-up for these patients is recommended.
