Survival in adult osteosarcoma patients after resection of isolated pulmonary metastases —a single-center experience
, 2, 1, 3, 1, 1, 3
Abstract
Introduction. Data on factors affecting disease recurrence and survival after pulmonary metastasectomy in adult osteosarcoma patients are still limited and inconclusive.
Material and methods. The study included 30 consecutive patients from a single institution who underwent resection of isolated osteosarcoma, with follow-up of pulmonary metastases over the period of 15 years between 1997 and 2012. Various perioperative variables were analyzed retrospectively to confirm the prognostic role of pulmonary surgery for overall and progression-free survival after metastasectomy. The multidisciplinary approach was implemented in qualification for repeated thoracic intervention.
Results. The overall 5-year survival rate (OS) after metastasectomy was 28% (median 27.5 months) and the 5-year progression-free survival rate (PFS) was 9% (median 6.33 months). Only radical pulmonary resection significantly influenced both OS (HR = 5.41; 95% CI 1.87–15.60, p = 0.002) and PFS (HR = 5.17; 95% CI 1.70–15.68, p = 0.004) after metastasectomy. The efficacy of thoracic surgery was independent of the patient’s age, sex, number of operable lung metastases, bilateral presence of lung metastases, or time to the appearance of lung metastases after surgery for osteosarcoma. Five-year OS and PFS after radical and nonradical pulmonary metastasectomy were 35% vs. 0% (p = 0.002) and 11% vs. 0% (p = 0.004), respectively. In the observed group, 60 thoracotomies were performed; 3 or more procedures were needed in 8 (27%) patients.
Conclusions. Similar to the population of children and adolescents, radical pulmonary metastasectomy may be a curative treatment strategy in selected adult patientswithmetastatic osteosarcoma. Repeated procedures are necessary in many cases.
Keywords: osteosarcomapulmonary metastasectomyadult patientsoutcome
References
- Kager L, Zoubek A, Pötschger U, et al. Cooperative German-Austrian-Swiss Osteosarcoma Study Group. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol. 2003; 21(10): 2011–2018.
- Gelderblom H, Jinks RC, Sydes M, et al. European Osteosarcoma Intergroup. Survival after recurrent osteosarcoma: data from 3 European Osteosarcoma Intergroup (EOI) randomized controlled trials. Eur J Cancer. 2011; 47(6): 895–902.
- Kempf-Bielack B, Bielack SS, Jürgens H, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. 2005; 23(3): 559–568.
- Blackmon SH, Shah N, Roth JA, et al. Resection of pulmonary and extrapulmonary sarcomatous metastases is associated with long-term survival. Ann Thorac Surg. 2009; 88(3): 877–84; discussion 884.
- ESMO/European Sarcoma Network Working Group. Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014; 25 Suppl 3: iii113–iii123.
- Savage SA, Mirabello L. Using epidemiology and genomics to understand osteosarcoma etiology. Sarcoma. 2011; 2011: 548151.
- Salah S, Fayoumi S, Alibraheem A, et al. The influence of pulmonary metastasectomy on survival in osteosarcoma and soft-tissue sarcomas: a retrospective analysis of survival outcomes, hospitalizations and requirements of home oxygen therapy. Interact Cardiovasc Thorac Surg. 2013; 17(2): 296–302.
- Lin AY, Kotova S, Yanagawa J, et al. Risk stratification of patients undergoing pulmonary metastasectomy for soft tissue and bone sarcomas. J Thorac Cardiovasc Surg. 2015; 149(1): 85–92.
- Kaifi JT, Gusani NJ, Deshaies I, et al. Indications and approach to surgical resection of lung metastases. J Surg Oncol. 2010; 102(2): 187–195.
- Ceppa DP. Results of Pulmonary Resection: Sarcoma and Germ Cell Tumors. Thorac Surg Clin. 2016; 26(1): 49–54.
- Daw NC, Chou AJ, Jaffe N, et al. Recurrent osteosarcoma with a single pulmonary metastasis: a multi-institutional review. Br J Cancer. 2015; 112(2): 278–282.
- Aljubran AH, Griffin A, Pintilie M, et al. Osteosarcoma in adolescents and adults: survival analysis with and without lung metastases. Ann Oncol. 2009; 20(6): 1136–1141.
- Ferrari S, Briccoli A, Mercuri M, et al. Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol. 2003; 21(4): 710–715.
- Putnam JB, Roth JA, Wesley MN, et al. Survival following aggressive resection of pulmonary metastases from osteogenic sarcoma: analysis of prognostic factors. Ann Thorac Surg. 1983; 36(5): 516–523.
- Harting MT, Blakely ML, Jaffe N, et al. Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma. J Pediatr Surg. 2006; 41(1): 194–199.
- Chen F, Miyahara R, Bando T, et al. Prognostic factors of pulmonary metastasectomy for osteosarcomas of the extremities. Eur J Cardiothorac Surg. 2008; 34(6): 1235–1239.
- Pfannschmidt J, Klode J, Muley T, et al. Pulmonary resection for metastatic osteosarcomas: a retrospective analysis of 21 patients. Thorac Cardiovasc Surg. 2006; 54(2): 120–123.
- Meyer WH, Schell MJ, Kumar AP, et al. Thoracotomy for pulmonary metastatic osteosarcoma. An analysis of prognostic indicators of survival. Cancer. 1987; 59(2): 374–379, doi: 10.1002/1097-0142(19870115)59:2<374::aid-cncr2820590235>3.0.co;2-6.
- Briccoli A, Rocca M, Salone M, et al. High grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985-2005. Surg Oncol. 2010; 19(4): 193–199.
- Buddingh EP, Anninga JK, Versteegh MIM, et al. Prognostic factors in pulmonary metastasized high-grade osteosarcoma. Pediatr Blood Cancer. 2010; 54(2): 216–221.
- Treasure T, Fiorentino F, Scarci M, et al. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open. 2012; 2(5).
- Briccoli A, Rocca M, Salone M, et al. Resection of recurrent pulmonary metastases in patients with osteosarcoma. Cancer. 2005; 104(8): 1721–1725.