title: Prognostic factors of pulmonary metastasectomy for osteosarcomas of the extremities.
abstract: 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.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.forename: Ryo
authors.initials: R
authors.lastname: Miyahara
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okubo
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Tomitaka
authors.initials: T
authors.lastname: Nakayama
authors.forename: Junya
authors.initials: J
authors.lastname: Toguchida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date