Pulmonary metastases in children with osteosarcoma: characteristics and impact on patient survival.
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.
Rasalkar
Darshana D
DD
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing St., Shatin, New Territories, Hong Kong.
Chu
Winnie C W
WC
Lee
Vincent
V
Paunipagar
Bhawan K
BK
Cheng
Frankie W T
FW
Li
Chi Kong
CK
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
Cancer Treat Rev. 2006 Oct;32(6):423-36
16860938
J Clin Oncol. 1994 Sep;12(9):1849-58
8083708
J Pediatr Surg. 1984 Apr;19(2):121-5
6327963
Ann Thorac Surg. 1984 Feb;37(2):123-7
6582807
J Clin Oncol. 2005 Jan 20;23(3):559-68
15659502
J Clin Oncol. 1992 Jan;10(1):5-15
1370176
J Pediatr Surg. 1977 Dec;12(6):983-90
271221
Cancer. 2006 Jan 15;106(2):403-12
16353204
Cancer. 2002 Jun 15;94(12):3277-84
12115361
Semin Thorac Cardiovasc Surg. 2003 Oct;15(4):457-63
14710388
Cancer. 1995 Mar 1;75(5):1084-93
7850705
J Natl Cancer Inst. 1997 Jun 4;89(11):783-9
9182976
J Nucl Med. 2003 Jun;44(6):930-42
12791822
Clin Orthop Relat Res. 1999 Jan;(358):27-35
9973973
Pediatr Blood Cancer. 2004 Dec;43(7):723-8
15390310
J Pediatr Surg. 2006 Jan;41(1):194-9
16410132
Semin Oncol. 2007 Jun;34(3):186-96
17560980
Cancer Res. 2001 Jan 15;61(2):577-81
11212252
Am J Surg. 1980 Jul;140(1):9-16
6930823
Semin Thorac Cardiovasc Surg. 2002 Jan;14(1):18-28
11977013
Tumori. 1988 Aug 31;74(4):421-7
3055577
Ann Oncol. 2001 Feb;12(2):209-16
11300326
J Clin Oncol. 1996 Mar;14(3):848-58
8622033
Cancer. 1984 Nov 15;54(10):2160-4
6593114
Eur J Cardiothorac Surg. 2008 Dec;34(6):1235-9
18757207
Arch Surg. 1989 Jan;124(1):122-6
2910240
Thorax. 1991 Oct;46(10):727-31
1750020
Clin Orthop Relat Res. 1998 Apr;(349):194-9
9584383
Ann Oncol. 1998 Aug;9(8):893-9
9789613
Cancer. 1992 Feb 1;69(3):698-708
1730120
Med Pediatr Oncol. 1999 Aug;33(2):110-2
10398186
J Clin Oncol. 1998 Feb;16(2):658-63
9469355
Cancer. 1997 Jan 15;79(2):245-54
9010097
J Clin Oncol. 1991 Apr;9(4):600-5
2066757
J Nucl Med. 2009 Mar;50(3):340-7
19258257
Semin Surg Oncol. 1990;6(5):297-302
2237090
J Clin Oncol. 1983 Apr;1(4):251-4
6583319
J Clin Oncol. 1984 May;2(5):425-31
6587016
Am J Surg. 1993 Nov;166(5):543-7
8238750
J Surg Oncol. 1972;4(5):482-510
4566220
Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):469-76
8306048
Eur Surg Res. 1974;6(4):247-63
4532080
Arch Pathol Lab Med. 1977 Jan;101(1):14-8
299812
J Pediatr Surg. 1981 Dec;16(6):928-33
6951026
J Clin Oncol. 2002 Aug 15;20(16):3470-7
12177108
Thorax. 1981 Sep;36(9):679-82
6171905
Ann Thorac Surg. 1995 Jun;59(6):1385-9; discussion 1390
7771815