title: Pulmonary metastases in children with osteosarcoma: characteristics and impact on patient survival.
abstract: BACKGROUND
  Approximately 15-20% of patients with osteosarcoma present with detectable metastatic disease and the majority of whom (85%) have pulmonary lesions as the sole site of metastasis. Previous studies have shown that the overall survival rate among patients with localized osteosarcoma without metastatic disease is approximately 60-70% whereas survival rate reduces to 10-30% in patients with metastatic disease.
  
  
  OBJECTIVE
  To determine the incidence and characteristic features of pulmonary metastases in a group of osteosarcoma patients and correlate the findings with the prognostic outcome/survival.
  
  
  METHODS
  Seventy-seven cases of histologically confirmed osteosarcoma were reviewed (47 male, 30 female, mean age 10.9). The site and size of the primary tumour and degrees of chemonecrosis were recorded. Lung metastases were analyzed according to their size, number, distribution and interval from diagnosis. The Kaplan-Meier method was used to analyze the survival probability curve. Significant differences (P < 0.05) were evaluated with the log-rank test for univariate analyses.
  
  
  RESULTS
  Seventeen patients had synchronous and 11 had metachronous lung metastases. Sixteen (57%) underwent pulmonary metastasectomy. Nine of sixteen (56%) patients with metastasectomy and 10/12 (83%) patients without metastasectomy died. Poor chemonecrosis was associated with a worse outcome. Number, distribution and timing of lung metastases, but not the size of lung metastases, were of prognostic value for survival.
  
  
  CONCLUSIONS
  Radiological detection of lung metastases is clinically important as it indicates a worse prognosis.
authors.affiliation: Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing St., Shatin, New Territories, Hong Kong.
authors.forename: Darshana D
authors.initials: DD
authors.lastname: Rasalkar
authors.forename: Winnie C W
authors.initials: WC
authors.lastname: Chu
authors.forename: Vincent
authors.initials: V
authors.lastname: Lee
authors.forename: Bhawan K
authors.initials: BK
authors.lastname: Paunipagar
authors.forename: Frankie W T
authors.initials: FW
authors.lastname: Cheng
authors.forename: Chi Kong
authors.initials: CK
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000556:secondary*; D008297:Male; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000556:secondary*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult
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