Department of Surgery, University of Texas Health Science Center, Houston, TX 77030, USA.
J Pediatr Surg. 2011 Jul;46(7):1333-7. doi: 10.1016/j.jpedsurg.2010.12.013.
The 3-year survival after pulmonary metastasectomy for osteosarcoma (OS) is approximately 30%. Resection of metastatic disease can prolong life in pediatric patients with OS. Our objective is to assess the outcome of pediatric patients with pulmonary metastases located centrally as compared with peripheral lesions.
A retrospective review of patients 0 to 21 years old with a diagnosis of OS with pulmonary metastases on computed tomographic scan between 1985 and 2000 was completed. Demographics, metastasis location, survival, morbidity, and mortality were evaluated.
Of 115 patients who had pulmonary metastasis secondary to OS, there were 96 wedge resections and 13 lobectomy/pneumonectomies in 84 patients. The morbidity of wedge resection was 9% and lobectomy/pneumonectomy was 8%. There were no deaths from surgery. The median survival for patients undergoing lobectomy compared with wedge resection was 0.61 and 1.14 years, respectively, but did not reach statistical significance. The median overall survival for the entire cohort was 0.75 years. The median overall survival after initial detection of metastatic disease was 1.06 years among the patients with peripheral disease, compared with 0.38 years in patients with central disease (P = .008).
Patients with central pulmonary metastases in OS have a very poor prognosis, even after operative treatment, compared with those with peripheral disease. Patients with central lesions may benefit from other nonsurgical treatment options.
骨肉瘤（OS）肺转移术后 3 年生存率约为 30%。切除转移病灶可以延长儿童 OS 患者的生命。我们的目的是评估中心型与周围型肺转移病灶的儿童患者的预后。
回顾性分析 1985 年至 2000 年间 CT 扫描诊断为骨肉瘤肺转移的 0 至 21 岁患者。评估患者的人口统计学、转移部位、生存情况、发病率和死亡率。
在 115 例因 OS 发生肺转移的患者中，84 例患者行 96 例楔形切除术和 13 例肺叶切除术/全肺切除术。楔形切除术的发病率为 9%，肺叶切除术/全肺切除术为 8%。无手术死亡。行肺叶切除术患者的中位生存期为 0.61 年，行楔形切除术患者的中位生存期为 1.14 年，但未达到统计学意义。全组患者的中位总生存期为 0.75 年。在有周围型病灶的患者中，初始发现转移病灶后中位总生存期为 1.06 年，而在有中央型病灶的患者中为 0.38 年（P =.008）。
与周围型病变相比，OS 患者的中央型肺转移预后极差，即使接受了手术治疗也是如此。中央型病变患者可能受益于其他非手术治疗选择。
