Harting Matthew T, Blakely Martin L, Jaffe Norman, Cox Charles S, Hayes-Jordan Andrea, Benjamin Robert S, Raymond A Kevin, Andrassy Richard J, Lally Kevin P
Department of Surgery, University of Texas Medical Sciences Center, Houston, TX 77030, USA.
J Pediatr Surg. 2006 Jan;41(1):194-9. doi: 10.1016/j.jpedsurg.2005.10.089.
Although survival without resection of pulmonary metastases from osteosarcoma is unlikely, not all surgeons agree on an aggressive surgical approach. We have taken an approach to attempt surgical resection if at all feasible regardless of number of metastases and disease-free interval (DFI). This study presents information on long-term follow-up after this aggressive approach to resection.
A single-institution retrospective cohort study of osteosarcoma patients younger than 21 years with pulmonary metastases, limited to the contemporary chemotherapeutic period (1980-2000), was conducted.
In 137 patients, synchronous (23.4%) or metachronous (76.6%) pulmonary nodules were identified. The median follow-up was 2.0 years (5 days to 20.1 years) for all patients. Overall survival among patients who had pulmonary nodules was 40.2% and 22.6% at 3 and 5 years, respectively. Ninety-nine patients underwent attempted pulmonary metastasectomy (mean survival, 33.6 months; 95% confidence interval, 25.1-42.1) and 38 patients did not (mean survival, 10.1 months; 95% confidence interval, 6.5-13.6; P < .001, t test). Characteristics that were associated with an increased likelihood of 5-year overall survival after pulmonary resection were primary tumor necrosis greater than 98% after neoadjuvant chemotherapy (P < .05) and DFI before developing lung metastases more than 1 year (P < .001). No statistically significant difference in overall survival or disease-free survival was found based on the number of pulmonary metastases resected. Characteristics including primary tumor size, site, or extension; chemotherapy; early vs late metastases; unilateral vs bilateral metastases; and resection margins did not significantly affect survival.
Most patient and tumor characteristics commonly used by surgeons to determine utility of resection of pulmonary metastases among patients with osteosarcoma are not associated with outcome. Biology of the particular tumor (response to preoperative chemotherapy, measured by tumor necrosis percentage, and DFI), as opposed to tumor burden, appears to influence survival more significantly. We would advocate considering repeat pulmonary resection for patients with recurrent metastases from osteosarcoma.
尽管骨肉瘤肺转移患者未经手术切除而存活的可能性不大，但并非所有外科医生都认同积极的手术方法。我们采取的方法是，无论转移灶数量和无病间期（DFI）如何，只要可行就尝试手术切除。本研究介绍了这种积极的切除方法后的长期随访信息。
对21岁以下患有肺转移的骨肉瘤患者进行单机构回顾性队列研究，研究限于当代化疗时期（1980 - 2000年）。
在137例患者中，发现有同时性（23.4%）或异时性（76.6%）肺结节。所有患者的中位随访时间为2.0年（5天至20.1年）。有肺结节患者的3年和5年总生存率分别为40.2%和22.6%。99例患者尝试进行了肺转移瘤切除术（平均生存时间33.6个月；95%置信区间为25.1 - 42.1），38例患者未进行手术（平均生存时间10.1个月；95%置信区间为6.5 - 13.6；t检验，P < 0.001）。与肺切除术后5年总生存率增加可能性相关的特征包括新辅助化疗后原发肿瘤坏死率大于98%（P < 0.05）以及发生肺转移前的DFI超过1年（P < 0.001）。根据切除的肺转移灶数量，在总生存或无病生存方面未发现统计学上的显著差异。包括原发肿瘤大小、部位或范围；化疗；早期与晚期转移；单侧与双侧转移；以及切除切缘等特征对生存无显著影响。
外科医生通常用于确定骨肉瘤患者肺转移瘤切除实用性的大多数患者和肿瘤特征与预后无关。与肿瘤负荷相反，特定肿瘤的生物学特性（通过肿瘤坏死百分比衡量的对术前化疗的反应以及DFI）似乎对生存有更显著的影响。我们主张考虑对骨肉瘤复发转移患者进行再次肺切除。
