Clinical observation and analysis of risk factors for pulmonary nodule outcomes in osteosarcoma patients

HAN Chang-sheng; CHEN Qian; XU Ming; ZHENG Kai; MIAO Zu-kang; YU Xiu-chun

doi:10.3969/j.issn.2095-252X.2025.05.006

Abstract：Objective To investigate the incidence of pulmonary nodules,imaging characteristics,and their correlation with lung metastasis in patients with osteosarcoma,and further explore the risk factors for lung metastasis in osteosarcoma patients based on CT imaging features.Methods A retrospective study was conducted on 79 osteosarcoma patients treated in the Department of Bone Diseases of our hospital from January 2016 to December 2022.Data on initial diagnosis age,surgical methods,primary tumor location,histological type,chemotherapy efficacy,follow-up duration,disease-free survival period,and CT imaging features of pulmonary nodules(maximum diameter,number,density,morphology,location,maximum CT value,and number of involved lung lobes)were collected.Patients were divided into normal and lung metastasis groups based on clinical outcomes,and differences in chest CT imaging features during different periods(initial diagnosis and treatment follow-up)were compared.The occurrence of lung metastasis in osteosarcoma patients was statistically analyzed,and the correlation between CT imaging features and lung metastasis during different periods was studied with survival analysis.Results Among the 79 cases,43(54.4%)had no nodules at initial diagnosis,while 36(45.5%)had pulmonary nodules.During the treatment follow-up period,26(32.94%)had no nodules,and 53(67.09%)had pulmonary nodules,including 44 new nodules.Significant differences were found between the two groups in chemotherapy efficacy,presence of pulmonary nodules at initial diagnosis,presence of pulmonary nodules during follow-up,and new nodules during follow-up(P<0.05).Multivariate analysis showed that patients with pulmonary nodules at initial diagnosis[HR=2.129,95%CI(1.049-4.319),P=0.036]and new nodules during follow-up[HR=14.431,95%CI(1.929-107.986),P=0.009]had a higher risk of lung metastasis.In terms of CT imaging features,significant differences were observed in nodule D Max and maximum CT value at initial diagnosis(P<0.05),and in nodule D Max,number,maximum CT value,density,and number of involved lung lobes during follow-up(P<0.05).Multivariate analysis identified initial nodule D Max≥5 mm[HR=7.705,95%CI(1.818-32.657),P=0.006],≥3 involved lung lobes[HR=5.534,95%CI(1.126-27.206),P=0.035],and maximum CT value≥-171 HU[HR=2.808,95%CI(1.051-7.504),P=0.040]as independent risk factors for lung metastasis.During follow-up,solid nodular density[HR=0.377,95%CI(0.146-0.974),P=0.044]and maximum CT value≥-171 HU[HR=15.637,95%CI(3.205-76.300),P<0.001]were independent risk factors affecting survival.Conclusions The presence of pulmonary nodules at initial diagnosis and new nodules during follow-up are associated with poor disease-free survival in osteosarcoma patients.Initial nodule D Max≥5 mm,≥3 involved lung lobes,and maximum CT value≥-171 HU are independent risk factors for lung metastasis.During follow-up,solid nodular density and maximum CT value≥-171 HU are independent risk factors for shorter disease-free survival in osteosarcoma patients with pulmonary nodules.