Survival after pulmonary metastasectomy for relapsed osteosarcoma

Area of Science:

• Oncology
• Surgical Oncology
• Medical Statistics

Background:

• Osteosarcoma recurrence with pulmonary metastases presents a significant challenge.
• Identifying effective treatment strategies for relapsed osteosarcoma is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the impact of pulmonary metastasectomy on postrelapse survival in patients with recurrent osteosarcoma.
• To analyze survival data using intent-to-treat and propensity score methods to minimize bias.

Main Methods:

• A cohort of 125 patients with relapsed osteosarcoma and pulmonary metastases was analyzed.
• Propensity score methods (matching, stratification, covariate adjustment, inverse probability of treatment weighting) were employed to balance patient characteristics.
• Cox proportional hazards regression and Kaplan-Meier analysis were used to assess survival outcomes.

Main Results:

• Patients undergoing pulmonary metastasectomy (n=59) showed significantly higher 2-year (68.4% vs 25.0%) and 5-year (41.0% vs 0%) survival rates compared to those receiving chemotherapy alone (n=66).
• Median postrelapse survival was markedly longer in the metastasectomy group (24.9 months vs 13.5 months).
• Pulmonary metastasectomy was an independent predictor of improved survival (HR, 0.185; P < .001), though benefits were limited in cases with extensive lung involvement or very high alkaline phosphatase levels.

Conclusions:

• Pulmonary metastasectomy is a valuable treatment associated with improved survival in patients with recurrent osteosarcoma.
• The survival benefit of metastasectomy should be considered in the context of disease extent and patient-specific factors.