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Updated: May 31, 2026
Practical Considerations in Studying Metastatic Lung Colonization in Osteosarcoma Using the Pulmonary Metastasis Assay
Published on: March 12, 2018
Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome
Phillip A Letourneau1, Lianchun Xiao, Matthew T Harting
1Department of Surgery, University of Texas Health Science Center, Houston, TX 77030, USA.
Insights
Pediatric osteosarcoma (OS) patients with central lung metastases have significantly poorer survival than those with peripheral lesions. Surgical options may not improve outcomes for central metastases, suggesting alternative treatments are needed.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Cancer Metastasis
Background:
- Pulmonary metastasectomy for osteosarcoma (OS) offers limited 3-year survival (~30%).
- Resection of metastatic disease can extend survival in pediatric OS patients.
- This study compares outcomes for central versus peripheral pulmonary metastases in pediatric OS.
Purpose of the Study:
- To assess the survival outcomes of pediatric patients with osteosarcoma and pulmonary metastases.
- To compare the prognosis of central versus peripheral pulmonary metastases in pediatric OS.
- To evaluate the impact of surgical intervention on survival based on metastasis location.
Main Methods:
- Retrospective review of pediatric patients (0-21 years) diagnosed with OS and pulmonary metastases (1985-2000).
- Evaluation of patient demographics, metastasis location (central vs. peripheral), survival, morbidity, and mortality.
- Analysis included wedge resections and lobectomy/pneumonectomies.
Main Results:
- Of 115 patients, 84 underwent pulmonary resection (96 wedge, 13 lobectomy/pneumonectomy) with low morbidity (9% wedge, 8% lobectomy) and no surgical deaths.
- Median survival was not statistically different between lobectomy (0.61 years) and wedge resection (1.14 years).
- Patients with central pulmonary metastases had significantly shorter median overall survival (0.38 years) compared to those with peripheral disease (1.06 years) (P = .008).
Conclusions:
- Central pulmonary metastases in pediatric osteosarcoma are associated with a very poor prognosis, even after surgical treatment.
- Peripheral pulmonary metastases in pediatric OS appear to have a better prognosis compared to central lesions.
- Alternative, non-surgical treatment strategies should be considered for pediatric patients with central OS pulmonary metastases.
Background:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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