Prognostic factors in pulmonary metastasized high-grade osteosarcoma

Pediatr Blood Cancer. 2010 Feb;54(2):216-21. doi: 10.1002/pbc.22293.


Introduction: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Combined Modality Therapy
  • Female
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery
  • Lung Neoplasms / therapy*
  • Male
  • Multivariate Analysis
  • Neoplasms, Multiple Primary
  • Neoplasms, Second Primary
  • Osteosarcoma / diagnosis
  • Osteosarcoma / secondary*
  • Osteosarcoma / surgery
  • Osteosarcoma / therapy*
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis