title: Prognostic factors in pulmonary metastasized high-grade osteosarcoma.
abstract: BACKGROUND
  Resection of pulmonary metastases has previously been reported to improve outcome in high-grade osteosarcoma (OS) patients. Factors influencing survival in OS patients with pulmonary metastases are important for clinical decision making.
  
  
  METHODS
  All 88 OS patients with pulmonary metastases either at diagnosis or during follow-up treated at the Leiden University Medical Center between January 1, 1990 and January 1, 2008 under the age of 40 were included in this study, including 79 cases of conventional, 8 cases of telangiectatic and 1 case of small cell OS.
  
  
  RESULTS
  In total, 56 of 88 patients with pulmonary metastases were treated by metastasectomy. Resectability of pulmonary metastases was the main prognostic factor. In patients with primary non-metastatic OS, a longer relapse free interval to pulmonary metastases was significantly associated with better survival (P = 0.02). Independent risk factors determining worse survival after metastasectomy in multivariate analysis were male sex (P = 0.05), higher number of pulmonary nodules (P = 0.03), and non-necrotic metastases (P = 0.04). Whether surgery for recurrent pulmonary metastases was performed did not influence survival. Histological subtype of the primary tumor, histological response in the primary tumor after neo-adjuvant chemotherapy, occurrence of local relapse, local resection or amputation of the primary tumor and age at diagnosis did not influence outcome.
  
  
  CONCLUSIONS
  This cohort of patients with detailed follow-up data enabled us to identify important risk factors determining survival in OS patients with pulmonary metastases. We demonstrate that after repeated metastasectomies, a subset of patients can be cured.
authors.affiliation: Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Emilie P
authors.initials: EP
authors.lastname: Buddingh
authors.forename: Jakob K
authors.initials: JK
authors.lastname: Anninga
authors.forename: Michel I M
authors.initials: MI
authors.lastname: Versteegh
authors.forename: Antonie H M
authors.initials: AH
authors.lastname: Taminiau
authors.forename: R Maarten
authors.initials: RM
authors.lastname: Egeler
authors.forename: Catherina S P
authors.initials: CS
authors.lastname: van Rijswijk
authors.forename: Pancras C W
authors.initials: PC
authors.lastname: Hogendoorn
authors.forename: Arjan C
authors.initials: AC
authors.lastname: Lankester
authors.forename: Hans
authors.initials: H
authors.lastname: Gelderblom
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary; D016609:Neoplasms, Second Primary; D012516:Osteosarcoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis