Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients
Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients
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DOI：
10.1016/j.jpedsurg.2018.06.019
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发表时间：
2019-04-01
影响因子：
2.4
通讯作者：
Elshafiey, Maged
中科院分区：
文献类型：
--
作者：
Ahmed, Gehad;Zamzam, Manal;Elshafiey, Maged
背景：完全切除转移瘤是预测骨肉瘤肺转移患者生存的最好指标。对于肺转移发生时间对预后的影响，文献中一直存在争议。方法：我们回顾了2008年1月至2016年12月在本院行肺转移切除术的所有骨肉瘤肺转移患者的临床过程。每个接受转移切除的患者被分成三组，根据肺转移是在最初出现(组1)、在化疗过程中发展(组2)还是在化疗结束后出现(组3)。结果：共确诊肺结节170例，其中99例(58.2%)接受了至少一次转移瘤切除术(149例开胸手术)。良性肺结节11例，排除肺结节。其余88例患者分为第1组(37例)、第2组(18例)和第3组(33例)。中位随访期为35个月(8~99个月)。术后5年总生存率(OS)为38.1+/-6.4%，无事件生存率(EFS)为25+/-5.3%。按转移后5年OS和EFS分组，第1组分别为34.3+/-13%和18+/-9.3%，第2组分别为8+/-6.5%和6.5%，第3组分别为52+/-11.4%和25+/-9%(P<；0.001)。单因素分析显示，肺转移发生的时间和发现的肺结节数是影响患者生存的唯一有意义的因素。结论：肺转移发生的时间是影响骨肉瘤患者预后的重要因素。在化疗期间发生转移的患者的存活率最差。(C)2018 Elsevier Inc.保留所有权利。
Background: 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.Methods: 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.Results: 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.Conclusion: 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. (C) 2018 Elsevier Inc. All rights reserved.