Background and objective: Osteosarcoma is the most frequent primary cancer of bone. The incidence is higher in adolescents. Large improvement, though, has been made in the treatment of osteosarcoma under the framework of multidisciplinary team, an important prognostic factor for osteosarcoma is pulmonary metastasis. Surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. Undoubtedly, surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. However, since current conceptions within the surgical approach to lung metastasectomy involve multidisciplinary collaboration, which are highly variable,there is not neither consensus nor standardized practice patterns. We conduct a survey aiming to reveal areas of consistency in current clinical practice on lung metastasectomy among Chinese osteosarcoma high volume centers.
Methods: A questionnaire survey specific to the nationwide high volume centers of osteosarcoma was conducted from September 2015 to November 2015. Analyses were stratified by hospital, working duration, case volume and medical discipline.
Results: Of 150 invited physicians, 105 participated, resulting in an overall response rate of 70%. Forty-one percent of the responded physicians agreed with the statement that orthopedic oncology should play a predominant role in the multidisciplinary team. More than 64% of respondents chose metastasectomy as the preferred local control approach, and up to 78.1% of respondents recommended pulmonary metastasectomy for patients. Compared with orthopedic surgeons, other physicians were significantly more likely to report not advocating pulmonary metastasectomy in their practice (OR(others)=0.02; 95%CI: 0.00-0.22; P=0.001), and thoracic surgeons were more likely to decide metastasectomy according to indications rather than the number limit of metastases (OR(thoracic surgeons)=20.93; 95%CI: 2.05-213.64; P=0.001). For the most preferred radiographic evaluation option, approximately 83% of respondents reported diagnostic use of computed tomography (CT). More than 70% of respondents reported that chest CT follow-up should be 3 months after the primary site resection; approximately 68% deemed the diagnostic accuracy of CT about 90%; most respondents (92%) recommended the extrapulmonary imaging evaluation simultaneously. Around 46% of respondents reported that survival duration longer than 6 months after pulmonary metastasectomy is beneficial.
Conclusion: This study offers new information about the variability in the reported management of pulmonary metastatic osteosarcoma in China, reflecting the deficiencies in unified practice patterns. The results of this survey also provide baseline data for future research and for the development of international guidelines.
背景与目的 骨肉瘤是最常见的骨原发恶性肿瘤，好发于青少年。尽管多学科框架下骨肉瘤的治疗已经取得瞩目成就，然而影响骨肉瘤远期生存的重要因素是肺转移。约有 1/2 以上患者在其病程的不同时期会发生肺转移，其中 10%~15%为同时性肺转移。毋庸置疑，治疗肺转移瘤的首选方法为外科切除，但因骨肉瘤肺转移的诊疗涉及多学科多专业，而由于各学科之间的理念存在差异，因此尚未形成标准化的诊疗模式。本研究通过问卷调查方式旨在了解当前我国骨肉瘤大型医疗中心在此领域中的诊疗模式现况。方法 2015年9月-2015年11月期间，一项关于骨肉瘤肺转移的诊疗现况问卷在全国骨肉瘤大型诊疗中心范围内开展。根据调查对象所在单位、工作年限、年均收治病例数及医学专业不同，进一步行分层分析。结果 调查共发放问卷150份，回收有效问卷105份，总应答率为70%。首先，关于骨肉瘤肺转移治疗的核心问题，41.0%的调查对象认同骨肿瘤外科专业在骨肉瘤肺转移多学科诊疗实践中的主导地位；首选肺转移瘤切除术作为转移灶局部控制措施的比例约64%；78.1%的调查对象会推荐患者行肺转移瘤切除术；骨科及胸外科医师较之其他专业更加积极（同骨科专业相比，OR其他专业=0.02；95%CI：0.00-0.22；P=0.001）；胸外科医师更倾向根据经验决定肺转移瘤切除术的指证，而非受限于病灶具体数目（OR胸外科专业=20.93；95%CI：2.05-213.64；P=0.001）。其次，关于骨肉瘤肺转移影像学诊断方法，约83%首选胸部计算机断层扫描（computed tomography, CT）；约70%的调查对象推荐原发灶切除术后3个月行胸部CT随诊；约68%认为CT诊断准确度90%水平；约92%同时推荐行肺外影像学评估。最后，关于术后生存获益的定义问题，约46%认为肺转移瘤术后生存期超过6个月即为生存获益。结论 本次问卷调查提供了我国骨肉瘤肺转移诊疗模式的现况信息，其反映出缺少统一规范诊疗模式的不足。调查结果为今后研究方向及国际性临床指南提供了基线数据。.