Avaliação da ressecção de metástases pulmonares em pacientes com osteossarcoma operados no período de 2005 a 2015
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Data
2018-08-02
Autores
Reis, Alcania Walburga de Souza Pereira dos [UNIFESP]
Orientadores
Petrilli, Antonio Sergio [UNIFESP]
Tipo
Dissertação de mestrado
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Introdução: o osteossarcoma (OS) é o tumor maligno primário ósseo mais comum na infância e na adolescência. O pior fator prognóstico associado à doença é a presença de metástase ao diagnóstico. Dentre os pacientes com doença metastática, há tendência a melhor resposta ao tratamento com cura através de ressecção completa quando há presença apenas de lesões pulmonares. Objetivos: avaliar o impacto da ressecção de nódulos pulmonares em pacientes com suspeita de metástase de OS Métodos: revisão de banco de dados de 36 pacientes com OS metastático diagnosticados no período de 2005 a 2015 no IOP/GRAACC/UNIFESP. Resultados: dentre os 36 pacientes incluídos no estudo, 19,4% foram considerados inoperáveis ao diagnóstico. Dos 29 pacientes operados, 9 (30%) pacientes apresentaram lesões falso positivas. No procedimento cirúrgico foram ressecados 266 nódulos, sendo que apenas 43,6% destes nódulos haviam sido diagnosticados na tomografia de tórax, mostrando que a ressecção cirúrgica foi 3,4 vezes superior na identificação dos nódulos em relação ao exame de imagem. Dos 29 pacientes operados, 48,2% tinham nódulo único (incluindo nódulos menores que 0,5 cm até maiores que 1cm) com diagnóstico de metástase de OS em 70% destes após o procedimento. A taxa de sobrevida global na nossa população foi de 52,3 meses e, quando excluídos os falso-positivos, a estimativa média de sobrevivência foi de 41 meses. Documentamos também que ser verdadeiramente metastático apresenta risco de óbito 8,08 vezes maior que não ser metastático. Quando analisamos os pacientes recidivados, quase 50% destes que puderam ser abordados 3 ou mais vezes tiveram taxa de sobrevida global superior ao grupo que não conseguiu ser abordado cirurgicamente. Conclusões: Nosso trabalho mostrou que os pacientes que ressecaram completamente as lesões pulmonares tiveram importante impacto na taxa de sobrevida global em relação aqueles que não operaram. Mostramos ainda que a taxa de falso-positivo é ao redor de 30%. Contudo, novos protocolos de tratamento para o OS na tentativa de melhorar as curvas de sobrevida devem elaborar novas estratégias que reduzam os falsos-positivos e aumentem a sensibilidade diagnóstica.
Introduction: Osteosarcoma (OS) is the most common primary malignant bone tumor in childhood and adolescence. The worst prognostic factor associated with the disease is the presence of metastasis at diagnosis. Among patients with metastatic disease, there is a trend towards a better response to treatment with cure through complete resection when only lung lesions are present. Objectives: To evaluate the impact of resection of pulmonary nodules in patients with suspected OS metastasis. Methods: Review database of 36 patients with metastatic OS diagnosed in the period 2005 to 2015 in IOP / GRAACC / UNIFESP. Results: Among the 36 patients included in the study, 19.4% were considered inoperable at diagnosis. Of the 29 patients operated on, 9 (30%) patients had false positive lesions. In the surgical procedure, 266 nodules were resected, and only 43.6% of these nodules had been diagnosed on chest tomography, showing that the surgical resection was 3.4 times greater in the identification of nodules in relation to the imaging examination. Of the 29 patients operated on, 48.2% had a single nodule (including nodules smaller than 0.5 cm to greater than 1 cm) with a diagnosis of OS metastasis in 70% of them after the procedure. The overall survival rate in our population was 52.3 months, and when false-positives were excluded, the median survival estimate was 41 months. We also documented that being truly metastatic presents a risk of death 8.08 times greater than non-metastatic. When we analyzed the relapsed patients, almost 50% of those that could be approached 3 or more times had an overall survival rate higher than the group that could not be approached surgically. Conclusions: Our study showed that patients who completely resected lung lesions had an important impact on the overall survival rate in relation to those who did not. We also show that the false-positive rate is around 30%. However, new treatment protocols for OS in an attempt to improve survival curves should devise new strategies that reduce false positives and increase diagnostic sensitivity.
Introduction: Osteosarcoma (OS) is the most common primary malignant bone tumor in childhood and adolescence. The worst prognostic factor associated with the disease is the presence of metastasis at diagnosis. Among patients with metastatic disease, there is a trend towards a better response to treatment with cure through complete resection when only lung lesions are present. Objectives: To evaluate the impact of resection of pulmonary nodules in patients with suspected OS metastasis. Methods: Review database of 36 patients with metastatic OS diagnosed in the period 2005 to 2015 in IOP / GRAACC / UNIFESP. Results: Among the 36 patients included in the study, 19.4% were considered inoperable at diagnosis. Of the 29 patients operated on, 9 (30%) patients had false positive lesions. In the surgical procedure, 266 nodules were resected, and only 43.6% of these nodules had been diagnosed on chest tomography, showing that the surgical resection was 3.4 times greater in the identification of nodules in relation to the imaging examination. Of the 29 patients operated on, 48.2% had a single nodule (including nodules smaller than 0.5 cm to greater than 1 cm) with a diagnosis of OS metastasis in 70% of them after the procedure. The overall survival rate in our population was 52.3 months, and when false-positives were excluded, the median survival estimate was 41 months. We also documented that being truly metastatic presents a risk of death 8.08 times greater than non-metastatic. When we analyzed the relapsed patients, almost 50% of those that could be approached 3 or more times had an overall survival rate higher than the group that could not be approached surgically. Conclusions: Our study showed that patients who completely resected lung lesions had an important impact on the overall survival rate in relation to those who did not. We also show that the false-positive rate is around 30%. However, new treatment protocols for OS in an attempt to improve survival curves should devise new strategies that reduce false positives and increase diagnostic sensitivity.
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REIS, Alcânia Walburga de Souza Pereira dos. Avaliação da ressecção de metástases pulmonares em pacientes com osteossarcoma operados no período de 2005 a 2015. 2018. 59 f. Dissertação (Mestrado em Pediatria e ciências aplicadas à pediatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2018