Ahmed Gehad, Zamzam Manal, Kamel Ahmed, Ahmed Sonia, Salama Asmaa, Zaki Iman, Kamal Nehal, Elshafiey Maged
Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt; Surgical Oncology Department, Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.
Pediatric Oncology Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt.
J Pediatr Surg. 2019 Apr;54(4):775-779. doi: 10.1016/j.jpedsurg.2018.06.019. Epub 2018 Jun 23.
Complete metastasectomy is the best predictor of survival in patients with osteosarcoma pulmonary metastases. There has been some controversy in the literature regarding the prognostic significance of the timing of occurrence of lung metastasis.
We reviewed the clinical course of all osteosarcoma patients with pulmonary metastases treated by metastasectomy in our hospital from January 2008 through December 2016. Each patient who underwent metastasectomy was placed into one of three groups based on whether lung metastases were present at initial presentation (Group 1), developed during chemotherapy (Group 2), or appeared after completion of chemotherapy (Group 3). Data were obtained retrospectively and follow-up was obtained until the end of June 2017.
We identified 170 patients with pulmonary nodules of whom 99 (58.2%) underwent at least one metastasectomy (149 thoracotomies). Eleven patients had benign pulmonary nodules and were excluded. The other 88 patients were classified as Group 1 (37), Group 2 (18) or Group 3 (33). The median follow-up was 35 months (range 8 to 99). Postmetastasis 5-year overall survival (OS) was 38.1 ± 6.4%; event-free survival (EFS) was 25 ± 5.3%. By group, postmetastasis 5-year OS and EFS were 34.3 ± 13% and 18 ± 9.3% in Group 1, 8 ± 6.5% and 6.5 ± 5% in Group 2, and 52 ± 11.4% and 25 ± 9% in Group 3 (P < 0.001). In univariate analysis, the only significant factors associated with survival were timing of occurrence of lung metastasis and the number of lung nodules found.
The timing of occurrence of lung metastasis is an important prognostic factor among osteosarcoma patients eligible for metastasectomy. Patients whose metastases occurred during chemotherapy had the worst survival.
Level II.
完全性肺转移瘤切除术是骨肉瘤肺转移患者生存的最佳预测指标。关于肺转移发生时间的预后意义，文献中存在一些争议。
我们回顾了2008年1月至2016年12月在我院接受肺转移瘤切除术的所有骨肉瘤肺转移患者的临床病程。根据初次就诊时是否存在肺转移（第1组）、化疗期间出现肺转移（第2组）或化疗结束后出现肺转移（第3组），将每例接受肺转移瘤切除术的患者分为三组。数据为回顾性获取，随访至2017年6月底。
我们确定了170例肺结节患者，其中99例（58.2%）接受了至少一次肺转移瘤切除术（149次开胸手术）。11例患者有良性肺结节，被排除在外。其余88例患者分为第1组（37例）、第2组（18例）或第3组（33例）。中位随访时间为35个月（范围8至99个月）。转移后5年总生存率（OS）为38.1±6.4%；无事件生存率（EFS）为25±5.3%。按组分析，转移后5年OS和EFS在第1组分别为34.3±13%和18±9.3%，在第2组分别为8±6.5%和6.5±5%，在第3组分别为52±11.4%和25±9%（P<0.001）。单因素分析显示，与生存相关的唯一显著因素是肺转移的发生时间和发现的肺结节数量。
肺转移的发生时间是适合进行肺转移瘤切除术的骨肉瘤患者的重要预后因素。化疗期间发生转移的患者生存率最差。
二级。
