Can necrotic depth be a substitute of necrotic volume to predict collapse progression in osteonecrosis of the femoral head?

OBJECTIVE: Although some patients may experience collapse progression while others may not in post-collapse osteonecrosis of the femoral head (ONFH) with a necrotic lesion located within the weight-bearing part of the acetabulum (Type B/C1), few studies have focused on the natural course after collapse. This study aimed to clarify the correlation between necrotic volume (NV) and necrotic depth (ND) in predicting collapse progression in patients with post-collapse ONFH Type B/C1. MATERIALS AND METHODS: We retrospectively reviewed 54 hips with post-collapse ONFH Type B/C1 from 52 consecutive patients who were conservatively followed up for more than 1 year. We measured the amount of femoral head collapse using biplane radiographs at each follow-up period, and produced Kaplan-Meier survival curves with collapse progression (≥ 1 mm) as the endpoint. We compared NV and ND, which were calculated as the ratio of the distance from the articular surface of the femoral head to the deepest point of a necrotic lesion to the femoral head diameter in the mid-coronal slice of T1-weighted magnetic resonance imaging (MRI). RESULTS: We observed collapse progression in 31 hips (57.4%). The NV and ND were significantly greater in hips with collapse progression than in those without collapse progression (p = 0.0127 and 0.0047, respectively). Necrotic volume was significantly correlated with ND　(rs = 0.56, p < 0.0001). CONCLUSION: This study suggests that necrotic depth on the mid-coronal slice of T1-weighted MRI can be a substitute for necrotic volume to predict collapse progression in ONFH Type B/C1.

Does the Use of Peripheral Immune-Related Markers Indicate Whether to Administer Pazopanib, Trabectedin, or Eribulin to Advanced Soft Tissue Sarcoma Patients?

Pazopanib, trabectedin, and eribulin are administered for the treatment of soft tissue sarcomas (STSs); however, there is little consensus on which agent should be preferentially used in a clinical setting. This study assessed whether peripheral immune-related markers served as a useful reference when selecting pazopanib, trabectedin, or eribulin. This study included 63 patients who were administered pazopanib, trabectedin, or eribulin for advanced STSs between March 2015 and December 2020. Patients were divided into three groups based on the first drug administered among these three drugs. Differences in overall survival (OS) or progression-free survival (PFS) among the three groups were analyzed. OS showed no significant differences among the drugs administered first. For patients with low neutrophil-to-lymphocyte ratio (NLR), the OS of patients administered pazopanib as the first choice was shorter than the others (hazard ratio [HR] = 9.53, 95% confidence interval [CI] = 1.94-18.13, p = 0.0018). In the low platelet-to-lymphocyte ratio (PLR) subgroup, the OS of the patients administered eribulin for the first choice was longer than that of the others (HR = 0.32, 95%CI = 0.10-0.98, p = 0.046). Therefore, NLR and PLR might be used as prognostic indicators to dictate whether STS patients receive pazopanib, trabectedin, or eribulin.