What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study
Background: Sarcomas are rare, aggressive cancers which frequently metastasise to the lungs. Following diagnosis, patients typically undergo staging by means of a CT scan of their chest. This often identifies indeterminate pulmonary nodules (IPNs), but the significance of these in high-grade soft ti...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/15/13/3531 |
| _version_ | 1797591965454303232 |
|---|---|
| author | Marcus J. Brookes Corey D. Chan Timothy P. Crowley Maniram Ragbir Thomas Beckingsale Kanishka M. Ghosh Kenneth S. Rankin |
| author_facet | Marcus J. Brookes Corey D. Chan Timothy P. Crowley Maniram Ragbir Thomas Beckingsale Kanishka M. Ghosh Kenneth S. Rankin |
| author_sort | Marcus J. Brookes |
| collection | DOAJ |
| description | Background: Sarcomas are rare, aggressive cancers which frequently metastasise to the lungs. Following diagnosis, patients typically undergo staging by means of a CT scan of their chest. This often identifies indeterminate pulmonary nodules (IPNs), but the significance of these in high-grade soft tissue sarcoma (STS) is unclear. Identifying whether these are benign or malignant is important for clinical decision making. This study analyses the clinical relevance of IPNs in high-grade STS. Methods: All patients treated at our centre for high-grade soft tissue sarcoma between 2010 and 2020 were identified from a prospective database. CT scans and their reports were reviewed, and survival data were collected from patient records. Results: 389 suitable patients were identified; 34.4% had IPNs on their CT staging scan and 20.1% progressed into lung metastases. Progression was more likely with IPNs ≥ 5 mm in diameter (<i>p</i> = 0.006), multiple IPNs (<i>p</i> = 0.013) or bilateral IPNs (<i>p</i> = 0.022), as well as in patients with primaries ≥ 5 cm (<i>p</i> = 0.014), grade 3 primaries (<i>p</i> = 0.009) or primaries arising deep to the fascia (<i>p</i> = 0.041). The median time to progression was 143 days. IPNs at diagnosis were associated with an increased risk of developing lung metastases and decreased OS in patients with grade 3 STS (<i>p</i> = 0.0019 and <i>p</i> = 0.0016, respectively); this was not observed in grade 2 patients. Conclusions: IPNs at diagnosis are associated with significantly worse OS in patients with grade 3 STS. It is crucial to consider the primary tumour as well as the IPNs when considering the risk of progression. Surveillance CT scans should be carried out within 6 months. |
| first_indexed | 2024-03-11T01:45:06Z |
| format | Article |
| id | doaj.art-5119b53771a34ec689c2117241300248 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:45:06Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-5119b53771a34ec689c21172413002482023-11-18T16:18:20ZengMDPI AGCancers2072-66942023-07-011513353110.3390/cancers15133531What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort StudyMarcus J. Brookes0Corey D. Chan1Timothy P. Crowley2Maniram Ragbir3Thomas Beckingsale4Kanishka M. Ghosh5Kenneth S. Rankin6North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKNorth of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UKBackground: Sarcomas are rare, aggressive cancers which frequently metastasise to the lungs. Following diagnosis, patients typically undergo staging by means of a CT scan of their chest. This often identifies indeterminate pulmonary nodules (IPNs), but the significance of these in high-grade soft tissue sarcoma (STS) is unclear. Identifying whether these are benign or malignant is important for clinical decision making. This study analyses the clinical relevance of IPNs in high-grade STS. Methods: All patients treated at our centre for high-grade soft tissue sarcoma between 2010 and 2020 were identified from a prospective database. CT scans and their reports were reviewed, and survival data were collected from patient records. Results: 389 suitable patients were identified; 34.4% had IPNs on their CT staging scan and 20.1% progressed into lung metastases. Progression was more likely with IPNs ≥ 5 mm in diameter (<i>p</i> = 0.006), multiple IPNs (<i>p</i> = 0.013) or bilateral IPNs (<i>p</i> = 0.022), as well as in patients with primaries ≥ 5 cm (<i>p</i> = 0.014), grade 3 primaries (<i>p</i> = 0.009) or primaries arising deep to the fascia (<i>p</i> = 0.041). The median time to progression was 143 days. IPNs at diagnosis were associated with an increased risk of developing lung metastases and decreased OS in patients with grade 3 STS (<i>p</i> = 0.0019 and <i>p</i> = 0.0016, respectively); this was not observed in grade 2 patients. Conclusions: IPNs at diagnosis are associated with significantly worse OS in patients with grade 3 STS. It is crucial to consider the primary tumour as well as the IPNs when considering the risk of progression. Surveillance CT scans should be carried out within 6 months.https://www.mdpi.com/2072-6694/15/13/3531indeterminate pulmonary nodules (IPNs)sarcomasoft tissue sarcomasurvivalmetastasismetastases |
| spellingShingle | Marcus J. Brookes Corey D. Chan Timothy P. Crowley Maniram Ragbir Thomas Beckingsale Kanishka M. Ghosh Kenneth S. Rankin What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study Cancers indeterminate pulmonary nodules (IPNs) sarcoma soft tissue sarcoma survival metastasis metastases |
| title | What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study |
| title_full | What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study |
| title_fullStr | What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study |
| title_full_unstemmed | What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study |
| title_short | What Is the Significance of Indeterminate Pulmonary Nodules in High-Grade Soft Tissue Sarcomas? A Retrospective Cohort Study |
| title_sort | what is the significance of indeterminate pulmonary nodules in high grade soft tissue sarcomas a retrospective cohort study |
| topic | indeterminate pulmonary nodules (IPNs) sarcoma soft tissue sarcoma survival metastasis metastases |
| url | https://www.mdpi.com/2072-6694/15/13/3531 |
| work_keys_str_mv | AT marcusjbrookes whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT coreydchan whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT timothypcrowley whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT maniramragbir whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT thomasbeckingsale whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT kanishkamghosh whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy AT kennethsrankin whatisthesignificanceofindeterminatepulmonarynodulesinhighgradesofttissuesarcomasaretrospectivecohortstudy |