Correlation Between Imaging Changes After Neoadjuvant Chemotherapy For Osteosarcoma And The Relationship Between Preoperative TCM Symptom Type And Prognosis

Objective:To study the relationship between imaging changes and prognosis after neoadjuvant chemotherapy in patients with osteosarcoma,and to analyze the correlation between preoperative TCM syndrome classification and prognosis.Methods:The medical records and imaging data（X-ray,CT,MRI）before and after neoadjuvant chemotherapy of 69 patients with osteosarcoma admitted to the 960^th Hospital of the People’s Liberation Army from January2012 to December 2021 were retrospectively analyzed,and they were divided into X-ray group,CT group and MRI group according to the different imaging data.There were 61 cases in the X-ray group,26 cases in the CT group and59 cases in the MRI group.According to the actual treatment results,patients in each group were divided into good prognosis group and poor prognosis group.In the X-ray group,the osteosarcoma imaging scoring system was used to calculate the X-ray score（XS）,in the CT group,Mimics Medical software was used to measure the mean CT value of tumor lesions（HUmean）,and in the MRI group,the maximum diameter of tumor（MTD）and the reference axis length of the involved bone（RBS）were measured by the Medical imaging system software（PACS）.The maximum tumor diameter ratio（MDR=MTD/RBS）was calculated.The change rates of XS,HUmean and MDR before and after neoadjuvant chemotherapy were calculated,and the relationship between the change rates and prognosis was analyzed.Receiver operating characteristic（ROC）curve was used to calculate the sensitivity,specificity and accuracy of each change rate,and a comprehensive image scoring system（CRS）was developed combining X-ray,CT and MRI.40 patients with osteosarcoma admitted to our hospital from January 2019 to December2021 were selected,and the TCM symptom questionnaire was filled in according to the symptoms and signs of preoperative patients.Combined with the textbook of“Traditional Chinese Medicine Bone Injury Science”and related literature,the TCM certificate type of osteosarcoma is divided into four types:qi stasis and blood stasis,poisonous heat and blazing evidence,liver and kidney deficiency evidence,and qi and blood deficiency evidence,and the patients are dialectically classified according to the content of the table.The prognosis of patients with different types of symptoms was analyzed,and the relationship between preoperative TCM syndrome and prognosis was discussed.Results:1.The change rate of XS in the good prognosis group of 58.57（23.75-100）×100%was significantly higher than that in the poor prognosis group of-12.50（-28.57-28.57）×100%,the difference was statistically significant（Z=-4.777,P=0.000）.The change rate of HUmean in good prognosis group（21.87±21.99）×100%was significantly higher than that in poor prognosis group（-0.18±9.30）×100%,the difference was statistically significant（t=3.537,P=0.002）.The change rate of MDR in good prognosis group was 4.59（2.45-11.04）×100%,which was significantly higher than that in poor prognosis group(-6.06（-18.96-0.37）×100%,and the difference was statistically significant（Z=-4.220,P=0.000）.2.The sensitivity,specificity and accuracy of XS were 92.3%,65.7%and 85.9%,93.8%,80%and 85%for HUmean,80.6%,82.1%and 82%for MDR,and 92.9%,81.8%and 91.6%for CRS,respectively.3.Among the preoperative TCM syndromes of osteosarcoma,the syndrome of Qi stagnation and blood stasis was the most common,followed by the syndrome of liver and kidney deficiency,the syndrome of toxic heat flourishing and the syndrome of qi and blood deficiency.There were no significant differences in the sex composition ratio,age composition ratio and tumor site composition ratio of different TCM symptom patients.The prognosis of different TCM patients was statistically significant（X2=9.785,P=0.018）.Positive syndrome（Qi stagnation and blood stasis syndrome,toxic heat incandescence syndrome）had a good prognosis（72.72%）,while deficiency syndrome（liver and kidney deficiency and deficiency of qi and blood）had a poor prognosis（77.78%）.Conclusion:XS,Humean and MDR are all related to the prognosis of patients.The comprehensive image scoring system established by combining X-ray,CT and MRI has a higher ability to evaluate the prognosis,and is superior to single image assessment.Preoperative syndromes of traditional Chinese medicine of osteosarcoma were related to prognosis,and empirical evidence suggested good prognosis,while deficiency syndromes suggested poor prognosis.