ABSTRACT
PURPOSE: The purpose of this study was to determine what factors predict recurrent lung metastatic disease in pediatric oncology patients. METHODS: A retrospective review of 50 patients who underwent resection of lung nodules that were positive for metastatic disease from 1998 to 2011 was performed. Risk factors for recurrence were determined by multi-variable logistic regression models. RESULTS: Fifty pediatric oncology patients underwent resection of discrete lung nodules seen on CT scans during work-up for metastasis or for routine surveillance. Out of this patient cohort, 23 (46%) patients had recurrent disease. The only significant factors that influenced risk of recurrence were original PET positive study (p<0.05) and patients with osteosarcoma (p<0.002). The type of surgical procedure, margins of original resection, race, age, gender, size, or the number of original nodules was not found to be significant. CONCLUSION: Patients with osteosarcoma and PET positive disease at original presentation appear to be at the highest risk of recurrent pulmonary metastatic disease. New pulmonary lesions in these patients should undergo biopsy to confirm metastatic disease.
Subject(s)
Lung Neoplasms/secondary , Osteosarcoma/secondary , Adolescent , Adult , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/secondary , Child , Child, Preschool , Female , Humans , Infant , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/epidemiology , Lung Neoplasms/surgery , Male , Melanoma/epidemiology , Melanoma/secondary , Neoplasms, Germ Cell and Embryonal/epidemiology , Neoplasms, Germ Cell and Embryonal/secondary , Osteosarcoma/epidemiology , Osteosarcoma/surgery , Positron-Emission Tomography , Prognosis , Recurrence , Retrospective Studies , Risk , Sarcoma/epidemiology , Sarcoma/secondary , Sarcoma/surgery , Thoracoscopy , Thoracotomy , Wilms Tumor/epidemiology , Wilms Tumor/secondary , Young AdultABSTRACT
PURPOSE: The purpose of the study was to develop a prediction rule regarding the factors that most accurately predict the diagnosis of a malignancy in a lung nodule in the pediatric oncology patient. METHODS: A retrospective review of pediatric oncology patients that underwent lung nodule resection between 1998 and 2007 was performed. Multivariable logistic regression was used to create a prediction rule. RESULTS: Fifty pediatric oncology patients underwent 21 thoracotomies and 48 thoracoscopies to resect discrete lung nodules seen on computed tomographic scans during workup for metastasis or routine surveillance. The mean nodule size was 10.43 ± 7.08 mm. The most significant predictors of malignancy in a nodule were peripheral location (odds ratio [OR], 9.1); size between 5 and 10 mm (OR, 2.78); location within the right lower lobe (OR, 2.43); and patients with osteosarcoma (OR, 10.8), Ewing sarcoma (OR, 3.05), or hepatocellular carcinoma (OR, 2.38). CONCLUSIONS: Lesions that are between 5 and 10 mm in size and peripherally located in patients with osteosarcoma, Ewing sarcoma, or hepatocellular carcinoma are most likely to be malignant. Use of a prediction rule can help guide clinical practice by determining which patients should undergo surgical resection of lung nodules and which patients may be closely observed with continued radiologic studies.
