Effect of concurrent metastatic disease on survival in children and adolescents undergoing lung resection for metastatic osteosarcoma

PurposeTo evaluate the impact of treated extra-pulmonary metastatic disease on overall (OS) and event-free survival (EFS) for pediatric osteosarcoma patients undergoing pulmonary metastatectomy.MethodsWe retrospectively reviewed pediatric patients who were treated for osteosarcoma at our institution from 2001 to 2011 and received pulmonary metastatectomy (n = 76). We compared OS and EFS between patients with metastases limited to the lungs (Group A, n = 58) to those with treated extra-pulmonary metastases (Group B, n = 18) at the time of first pulmonary metastatectomy.ResultsThe estimated median OS and EFS from first pulmonary metastatectomy were 2.0 years (95% CI 1.5–2.8 years) and 5.5 months (95% CI 3.0–8.1 months), respectively. Median OS was significantly greater for Group A (2.6 years, 95% CI 1.9–3.8) compared to Group B (0.9 years, 95% CI 0.6–1.5) (log rank p = 0.0001). Median EFS was significantly greater for Group A (7.9 months, 95% CI 5.0–10.7) compared to Group B (1.6 months, 95% CI 0.8–2.7) (log rank p < 0.0001). Independent predictors of OS included extra-pulmonary metastatic disease at the time of first thoracotomy, bilateral pulmonary metastases, and > 4 nodules resected at first thoracotomy (all p < 0.001).ConclusionsOsteosarcoma patients with treated extra-pulmonary metastatic disease at the time of pulmonary metastatectomy have significantly worse survival compared to those with disease limited to the lungs.