title: Effect of concurrent metastatic disease on survival in children and adolescents undergoing lung resection for metastatic osteosarcoma.
abstract: OBJECTIVE
  To evaluate the impact of treated extra-pulmonary metastatic disease on overall (OS) and event-free survival (EFS) for pediatric osteosarcoma patients undergoing pulmonary metastatectomy.
  
  
  METHODS
  We retrospectively reviewed pediatric patients who were treated for osteosarcoma at our institution from 2001 to 2011 and received pulmonary metastatectomy (n=76). We compared OS and EFS between patients with metastases limited to the lungs (Group A, n=58) to those with treated extra-pulmonary metastases (Group B, n=18) at the time of first pulmonary metastatectomy.
  
  
  RESULTS
  The estimated median OS and EFS from first pulmonary metastatectomy were 2.0years (95% CI 1.5-2.8years) and 5.5months (95% CI 3.0-8.1months), respectively. Median OS was significantly greater for Group A (2.6years, 95% CI 1.9-3.8) compared to Group B (0.9years, 95% CI 0.6-1.5) (log rank p=0.0001). Median EFS was significantly greater for Group A (7.9months, 95% CI 5.0-10.7) compared to Group B (1.6months, 95% CI 0.8-2.7) (log rank p<0.0001). Independent predictors of OS included extra-pulmonary metastatic disease at the time of first thoracotomy, bilateral pulmonary metastases, and >4 nodules resected at first thoracotomy (all p<0.001).
  
  
  CONCLUSIONS
  Osteosarcoma patients with treated extra-pulmonary metastatic disease at the time of pulmonary metastatectomy have significantly worse survival compared to those with disease limited to the lungs.
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Austen D
authors.initials: AD
authors.lastname: Slade
authors.affiliation: Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Warneke
authors.affiliation: Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Hughes
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas; Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas; Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Hayes-Jordan
authors.affiliation: Department of Pediatric Surgery, The University of Texas Medical School at Houston, Houston, Texas; Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas. Electronic address: MAustin@mdanderson.org.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D016609:Neoplasms, Second Primary / Q000601:surgery; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
keywords: Osteosarcoma; Pediatric and adolescent; Pulmonary metastases; Survival