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Prognostic factors of pulmonary metastasectomy for osteosarcomas of the extremities

^a Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^b Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^c Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
^d Department of Tissue Regeneration, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan

Received 5 May 2008; received in revised form 1 July 2008; accepted 14 July 2008.

^_* Corresponding author. Address: Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. Tel.: +81 75 751 3835; fax: +81 75 751 4647. (Email: hdate{at}kuhp.kyoto-u.ac.jp).

Background: Factors affecting recurrence and survival after pulmonary resection for metastatic osteosarcomas are controversial. To confirm a role for resection of pulmonary metastases for such tumors, we herein reviewed our institutional experience. Methods: Between 1989 and 2007, 23 patients with pulmonary metastases from osteosarcomas of the extremities underwent pulmonary resection. Various perioperative variables were investigated retrospectively to confirm a role for metastasectomy and to analyze prognostic factors for overall survival and disease-free survival after metastasectomy. Results: Overall survival rate after metastasectomy was 31% at 5 years. Disease-free survival rate was 19% at 5 years after pulmonary resection. On multivariate analysis, patients with less than five pulmonary metastases and patients without pulmonary metastases identified during pre- and postoperative chemotherapy presented significantly favorable overall survival (p = 0.015 and 0.0082, respectively). Furthermore, the number of pulmonary metastases less than five was the only significantly favorable prognostic factor for disease-free survival on univariate analysis (p = 0.0055). Conclusions: Current practice of pulmonary metastasectomy for osteosarcomas in our institution was well justified. The number of pulmonary metastases more than five and the advent of pulmonary metastases during pre- and postoperative chemotherapy seemed relevant to a worse prognosis.

Key Words: Lung • Metastasectomy • Osteosarcoma

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