Clinical Characteristics And Prognosis Factors Of Pulmonary Metastasis In Osteosarcoma

Objectives:To analyze the clinical characteristics of osteosarcoma patients with lung metastasis,to explore the diagnostic value of the clinical indicators for pulmonary metastasis of osteosarcoma,to analyze the risk factors and prognostic factors of pulmonary metastasis in osteosarcoma.Methods:Clinical datas of first admitted to The Third Affiliated Hospital of Kunming Medical College(The Tumor Cancer Hospital of Yunnan Province)between 01/01/2009 and 12/31/2016 was collected using the medical record borrowing and retrieval system of the who were diagnosed of osteosarcoma was collected 262 patiens were included.Record the general information and two-stage laboratory indicators for initial diagnosis of osteosarcoma and lung metastasis.Use SPSS 21.0 software for statistical analysis.Calculation of area(AUC)under Curve and optimal cut-off value of each Indexes by using receiver operating Curve(ROC).Compare the area of two ROC curves by using Medcalc software.Explore the diagnostic value of clinical indicators for pulmonary metastasis of osteosarcoma,And analyze the risk factors and prognostic factors of pulmonary metastasis in osteosarcoma.Results:The lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),platelet(PLT),sodium(Na+),tumor diameter have a low accuracy in the diagnosis of pulmonary metastasis in osteosarcoma,neutrophil-to-lymphocyte ratio(NLR),derived neutrophil-to-lymphocyte ratio(DNLR)have no clinical value for the diagnosis of pulmonary metastasis in osteosarcoma according to ROC curve analysis(P>0.05).The AUC of the PLT,LMR,and tumor diameter are in the top three,which are the best predictors for predicting lung metastasis.The three indicators were compared by ROC curve,and the diagnostic value of three indicators for predicting lung metastasis were not statistical difference(P>0.05).Subsequently,the combined value of the three indicators was better than the PLT+LMR(P=0.0055)and the PLT+tumor diameter(P=0.0023).There was no significant difference in the diagnostic value of PLT+LMR and PLT+tumor diameter(P=0.2756).The AUC of the three-index combined diagnosis:0.707,the specificity:70.8%,the sensitivity:64.8%.The incidence of lung metastases was 47.3%in 262 osteosarcoma patients.The high incidence of lung metastasis was within 3 years after osteosarcoma surgery.Compared with the non-lung metastasis group,patients with lung metastasis had larger tumor diametes,higher levels of NLR,PLR,LDH,ALP,and PLT,lower LMR levels,and lung metastases were more linkely to occur in extremity osteosarco-ma.Then,in order to eliminate the influence of confounding factors,the multivariate logistic analysis:LMR<4.58,LDH≥275U/L,ALP≥464U/L,PLT≥281X10^9/L,tumor diameter≥6.85cm and non-extremity bone were independent risk factors for pulmonary metastasis of osteosarcoma(P<0.05).There was no correlation between age,gender,primary surgery,stage,NLR,DNLR and lung metastasis.The 1-year,3-year,and 5-year survival rates of pulmonary metastasis in osteosarcoma were 65.6%,21.7%and 4.5%.The median survival time was 16.7 months in 124 patients of pulmonary metastasis in osteosarcoma.The univariate analysis showed:gender,age,primary site,tumor diameter,firstly diagnosed of NLR,PLR,LMR,DNLR,ALP,PLT,Na+,the changes of NLR,LMR,DNLR,LDH before and after lung metastasis were not associated with the prognosis of patients(P>0.05).The number of lung metastases,the treatment of lung metastases,the combined metastasis,the period of lung metastasis,the initial LDH,and the changes of PLR,PLT,and Na+before and after lung metastasis are related to the prognosis of osteosarcoma with lung metastasis(p<0.05).Multivariate survival analysis showed that the number of lung metastases,the period of lung metastasis,and the change of PLT before and after lung metastasis were independent prognostic factors of osteosarcoma patients with lung metastasis.Conclusions:1.The combined diagnosis of PLT,LMR,and tumor diameter can improve the diagnostic efficacy of pulmonary metastasis of osteosarcoma.2.LMR<4.58,LDH≥275U/L,ALP≥464U/L,PLT≥281 × 10^9/L,tumor diameter≥6.85cm,and non-extremities bone are independent risk factors for pulmonary metastasis of osteosarcoma.3.The number of lung metastases,the period of lung metastasis,and the change of PLT before and after lung metastasis are independent prognostic factors in osteosarcoma patients with lung metastasis.