Survival in adult osteosarcoma patients after resection of isolated pulmonary metastases —a single-center experience

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 patients with metastatic osteosarcoma. Repeated procedures are necessary in many cases.