J Korean Soc Radiol.  2014 Aug;71(2):58-64. 10.3348/jksr.2014.71.2.58.

Prognostic Factors for Improved Survival after Pulmonary Metastasectomy from Osteosarcoma

• Choi HS
• Park JH
• Choe DH

• KMID: 1819780
• DOI: http://doi.org/10.3348/jksr.2014.71.2.58

Abstract

PURPOSE
The aim of this study was to evaluate the clinical characteristics and chest computed tomography (CT) images of the patients who underwent pulmonary metastasectomy from osteosarcoma, and to identify the prognostic factors associated with the improvement of survival.
MATERIALS AND METHODS
Fifty-nine patients with pulmonary metastases from osteosarcoma were included. The prognoses of the patients were assessed by 5-year survival rate, after the pulmonary metastasectomy. The prognostic factors analyzed are as follows: age, sex, location of the primary osteosarcoma, disease-free interval (DFI) from the date of primary surgery to the date of pulmonary metastases on CT, number of pulmonary metastases, maximum diameter of largest pulmonary metastatic nodule, laterality (unilateral/bilateral), and location of pulmonary metastatic nodule(s). The log-rank test was used for univariate analyses, and the Cox proportional hazards model was used for multivariate analyses.
RESULTS
The 5-year survival rate was 33.89%. Multivariate analyses revealed that a DFI > 12 months [p = 0.041, hazard ratio = 0.504, 95% confidence interval (CI) = 0.254-1.001] and nodule unilaterality (p = 0.029, hazard ratio = 0.291, 95% CI = 0.096-0.883) were the independent prognostic factors affecting the 5-year survival. The 5-year survival rates of patients with a DFI > 12 months and unilaterality of the metastatic nodule(s) increased to 44.11% and 39.28%, respectively.
CONCLUSION
The prognostic factors associated with the improved survival after pulmonary metastasectomy from osteosarcoma were the DFI > 12 months and the unilaterality of the metastatic nodules.

MeSH Terms

Humans
Lung
Metastasectomy*
Multivariate Analysis
Neoplasm Metastasis
Osteosarcoma*
Prognosis
Proportional Hazards Models
Survival Rate
Thorax

Figure

• 

  Fig. 1 Metastatic osteosarcoma in a 28-year-old male patient with a disease-free interval of 33 months and unilateral metastases. A, B. Transverse lung window CT (5-mm slice thickness) scans obtained before metastasectomy show 2 metastatic nodules (arrows) in the left upper lobe and left lower lobe. C, D. Follow-up CT scans obtained at 70 months after wedge-resections show no evidence of local recurrence or distant metastasis.

• 

  Fig. 2 Metastatic osteosarcoma in a 71-year-old male patient with a disease-free interval of 3 months and bilateral metastases. A, B. Transverse lung window CT (5-mm slice thickness) scans obtained before metastasectomy show several metastatic nodules (arrows) in the left lower lobe and right lower lobe. C. Follow-up CT scans obtained at 3 months after wedge-resections show a recurrent metastatic nodule (arrow) in the left lower lobe.

• 

  Fig. 3 Comparison of the 5-year survival rate between patient groups with disease-free interval (DFI) > 12 months, laterality (unilateral) and other groups after metastasectomy for osteosarcoma.

Reference

1. Davidson RS, Nwogu CE, Brentjens MJ, Anderson TM. The surgical management of pulmonary metastasis: current concepts. Surg Oncol. 2001; 10:35–42.

2. Hornbech K, Ravn J, Steinbrüchel DA. Outcome after pulmonary metastasectomy: analysis of 5 years consecutive surgical resections 2002-2006. J Thorac Oncol. 2011; 6:1733–1740.

3. Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T. ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2008; 3:1257–1266.

4. Corona-Cruz JF, Domínguez-Parra LM, Saavedra-Pérez D, Jiménez-Fuentes E, Villarreal-Garza C, Green-Schneeweis L, et al. Lung metastasectomy: long-term outcomes in an 18-year cohort from a single center. Surg Oncol. 2012; 21:237–244.

5. Timmerman RD, Bizekis CS, Pass HI, Fong Y, Dupuy DE, Dawson LA, et al. Local surgical, ablative, and radiation treatment of metastases. CA Cancer J Clin. 2009; 59:145–170.

6. Glasser DB, Lane JM, Huvos AG, Marcove RC, Rosen G. Survival, prognosis, and therapeutic response in osteogenic sarcoma. The Memorial Hospital experience. Cancer. 1992; 69:698–708.

7. Rosen G, Marcove RC, Huvos AG, Caparros BI, Lane JM, Nirenberg A, et al. Primary osteogenic sarcoma: eight-year experience with adjuvant chemotherapy. J Cancer Res Clin Oncol. 1983; 106:Suppl. 55–67.

8. Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, et al. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol. 2000; 18:4016–4027.

9. Telander RL, Pairolero PC, Pritchard DJ, Sim FH, Gilchrist GS. Resection of pulmonary metastatic osteogenic sarcoma in children. Surgery. 1978; 84:335–341.

10. Harris MB, Gieser P, Goorin AM, Ayala A, Shochat SJ, Ferguson WS, et al. Treatment of metastatic osteosarcoma at diagnosis: a Pediatric Oncology Group Study. J Clin Oncol. 1998; 16:3641–3648.

11. Kempf-Bielack B, Bielack SS, Jürgens H, Branscheid D, Berdel WE, Exner GU, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. 2005; 23:559–568.

12. Saltzman DA, Snyder CL, Ferrell KL, Thompson RC, Leonard AS. Aggressive metastasectomy for pulmonic sarcomatous metastases: a follow-up study. Am J Surg. 1993; 166:543–547.

13. Girard P, Baldeyrou P, Le Chevalier T, Lemoine G, Tremblay C, Spielmann M, et al. Surgical resection of pulmonary metastases. Up to what number? Am J Respir Crit Care Med. 1994; 149(2 Pt 1):469–476.

14. Temeck BK, Wexler LH, Steinberg SM, McClure LL, Horowitz M, Pass HI. Metastasectomy for sarcomatous pediatric histologies: results and prognostic factors. Ann Thorac Surg. 1995; 59:1385–1389. discussion 1390.

15. Suzuki M, Iwata T, Ando S, Iida T, Nakajima T, Ishii T, et al. Predictors of long-term survival with pulmonary metastasectomy for osteosarcomas and soft tissue sarcomas. J Cardiovasc Surg (Torino). 2006; 47:603–608.

16. Dear RF, Kelly PJ, Wright GM, Stalley P, McCaughan BC, Tattersall MH. Pulmonary metastasectomy for bone and soft tissue sarcoma in Australia: 114 patients from 1978 to 2008. Asia Pac J Clin Oncol. 2012; 8:292–302.

17. Aljubran AH, Griffin A, Pintilie M, Blackstein M. Osteosarcoma in adolescents and adults: survival analysis with and without lung metastases. Ann Oncol. 2009; 20:1136–1141.

18. Ferrari S, Briccoli A, Mercuri M, Bertoni F, Picci P, Tienghi A, et al. Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol. 2003; 21:710–715.

19. Putnam JB Jr, Roth JA, Wesley MN, Johnston MR, Rosenberg SA. Survival following aggressive resection of pulmonary metastases from osteogenic sarcoma: analysis of prognostic factors. Ann Thorac Surg. 1983; 36:516–523.

20. Patel AN, Lamb J, Patel N, Santos RS, Stavropoulos C, Landreneau RJ. Clinical trials for pulmonary metastasectomy. Semin Thorac Cardiovasc Surg. 2003; 15:457–463.