title: The Clinical Significance of Initial Pulmonary Micronodules in Young Sarcoma Patients.
abstract: BACKGROUND
  The clinical significance of subcentimeter nodules identified on staging chest computed tomography (CT) for sarcoma remains unknown. Our goal was to evaluate the effect of initial pulmonary nodule size and number on survival rates in young, newly diagnosed sarcoma patients.
  
  
  METHODS
  Medical records were reviewed for all patients ≤50 years of age with primary, high-grade bone or soft tissue sarcoma at our institution over a 10-year period. This population was divided into patients with no nodules (group 1); 1 nodule <5 mm (group 2);>1 nodule <5 mm (group 3); and ≥1 nodule ≥5 mm (group 4). Kaplan-Meier analyses with log rank tests were performed to compare overall and disease-free survival between these 4 groups, as well as between patients with unilateral and bilateral nodules.
  
  
  RESULTS
  There were 74 patients in group 1 (59.2%), 26 in group 2 (21%), 11 in group 3 (9%), and 13 in group 4 (10%). Mean follow-up was 74 (range, 6 to 191 mo) months. Survival was only slightly worse with larger nodules but significantly worse with multiple nodules. In addition, patients with bilateral nodules had a significantly worse prognosis than those with multiple unilateral nodules.
  
  
  CONCLUSIONS
  These data suggest that in young patients with high-grade sarcoma, the number and distribution of subcentimeter pulmonary nodules are an important prognostic factor, whereas nodule size may be less relevant.
authors.affiliation: *Department of Orthopedic Oncology, Washington University in St. Louis, MO †Rush University School of Medicine Departments of §Orthopedic Oncology ∥Pediatric Oncology, Rush University Medical Center, Chicago, IL ‡Department of Pediatrics, Brigham and Women's Hospital, Boston, MA.
authors.forename: Cara
authors.initials: C
authors.lastname: Cipriano
authors.forename: Lauren
authors.initials: L
authors.lastname: Brockman
authors.forename: Jason
authors.initials: J
authors.lastname: Romancik
authors.forename: Robert
authors.initials: R
authors.lastname: Hartemayer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ording
authors.forename: Curt
authors.initials: C
authors.lastname: Ginder
authors.forename: Joel
authors.initials: J
authors.lastname: Krier
authors.forename: Steven
authors.initials: S
authors.lastname: Gitelis
authors.forename: Paul
authors.initials: P
authors.lastname: Kent
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary*; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult