Indeterminate pulmonary nodules are not associated with worse overall survival in Ewing Sarcoma

Abstract

Aim: Lung metastases are a negative prognostic factor in Ewing sarcoma, however, the incidence and significance of sub-centimetre pulmonary nodules at diagnosis is unclear. The aims of this study were to (1): determine the incidence of indeterminate pulmonary nodules (IPNs) in patients diagnosed with Ewing sarcoma (2); establish the impact of IPNs on overall and metastasis-free survival and (3) identify patient, oncological and radiological factors that correlate with poorer prognosis in patients that present with IPNs on their staging chest CT. Materials & methods: Between 2008 and 2016, 173 patients with a first presentation of Ewing sarcoma of bone were retrospectively identified from an institutional database. Staging and follow-up chest CTs for all patients with IPN were reviewed by a senior radiologist. Clinical and radiologic course were examined to determine overall-and metastasis-free survival for IPN patients and to identify demographic, oncological or nodule-specific features that predict which IPN represent true lung metastases. Results: Following radiologic re-review, IPN were found in 8.7% of patients. Overall survival for IPN patients was comparable to those with a normal staging chest CT (2-year overall survival of 73.3% [95% CI 43.6e89] and 89.4% [95% CI 81.6e94], respectively; p ¼ 0.34) and was significantly better than for patients with clear metastases (46.0% [95% CI 31.9e59]; p < 0.0001). Similarly, there was no difference in metastasis-free survival between 'No Metastases' and 'IPN' patients (p ¼ 0.16). Lung metastases developed in 40% of IPN patients at a median 9.6 months. Reduction of nodule size on neoadjuvant chemotherapy was associated with worse overall survival in IPN patients (p ¼ 0.0084). Conclusion: IPN are not uncommon in patients diagnosed with Ewing sarcoma. In this study, we were unable to detect a difference in overall-or metastasis-free survival between patients with IPN at diagnosis and patients with normal staging chest CTs.

What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study

“…Previous studies in other types of sarcoma have produced various results; Tsoi et al demonstrated worse OS in patients with IPNs in osteosarcoma [ 13 ], whilst Ghosh et al found no difference [ 14 ]. Tsoi et al also studied the relevance of IPNs in Ewing sarcoma, finding no difference in OS [ 15 ]. It is important to note that Tsoi et al’s sample size for their osteosarcoma study was significantly larger than the other two studies mentioned, allowing for much greater power to detect a difference.…”

Prognostic Impact of Pulmonary Metastasectomy in Bone Sarcoma Patients: A Retrospective, Single-Centre Study

“…Metastatic disease is a common cause of death in patients with bone sarcoma [ 1 ]. Synchronous metastases are present in 15–20% of osteosarcomas [ 2 , 3 , 4 ] and up to 25% of Ewing sarcomas [ 5 , 6 , 7 ], while 20–50% of osteosarcoma and Ewing sarcoma patients will develop secondary metastases, most commonly affecting the lungs [ 8 , 9 , 10 ]. Apart from chemotherapy (CTX) and radiotherapy (RTX), resection of metastases in general, and lung metastases in particular, has become an important therapeutic option in bone sarcoma patients [ 11 , 12 ], in addition to other local treatment options [ 13 ].…”