Prognostic Value of Timing of Pulmonary Metastases Identification in Osteosarcoma Patients
Authors: Antonio Briccoli, Michele Rocca, Hiroyuki Tsuchiya, Mohamed Abdel-Wanis, Yoshimitsu Kanazawa, Katsuro Tomita
Journal: Journal of Clinical Oncology (2002)

Article Tools Correspondence Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2003.99.181 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12506191 Prognostic Value of Timing of Pulmonary Metastases Identification in Osteosarcoma Patients Antonio BriccolixAntonio BriccoliSearch for articles by this author , Michele RoccaxMichele RoccaSearch for articles by this author Hiroyuki TsuchiyaxHiroyuki TsuchiyaSearch for articles by this author , Mohamed Abdel-WanisxMohamed Abdel-WanisSearch for articles by this author , Yoshimitsu KanazawaxYoshimitsu KanazawaSearch for articles by this author , Katsuro TomitaxKatsuro TomitaSearch for articles by this author Show More General Surgery, Rizzoli Orthopaedic Institute, Bologna, ItalyDepartment of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan https://doi.org/10.1200/JCO.2003.99.181 Full Text PDF Figures and Tables "Prognostic Value of Timing of Pulmonary Metastases Identification in Osteosarcoma Patients." Journal of Clinical Oncology, 21(1), pp. 177–178© 2003 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyIn Reply:112003In our article, we investigated the clinical course of patients with osteosarcoma after the patients develop lung metastasis, dividing the patients into four groups, depending on timing of identification of lung metastases.1 Few data exist on the literature about the effect of relapse of pulmonary metastatic disease from osteosarcoma on patient survival.2 Unfortunately, Professor Briccoli did not report the total survival of the 65 patients of recurrent pulmonary metastases reported in his letter. However, the data supplied by Professor Briccoli would be complementary to our data and an addition toward better understanding of the factors affecting the survival of osteosarcoma patients with pulmonary metastases at different stages of their disease. This might help to detect patients who are good candidates for metastasectomy. Unfortunately, our article is a multicenter study, and the questionnaire did not include sufficient data about the relapse of lung metastases, so we could not confirm the reproducibility of results obtained by Professor Briccoli on patients of our study. To answer his comments, timing of local recurrence of the primary tumor should also be considered.We tested the prognostic importance of age and local recurrence of the primary tumor on the survival of all osteosarcoma patients with lung metastases that we reported in our article. With regard to age, patients were divided into six groups (<10, 10 to < 15, 15 to < 20, 20 to < 30, 30 to < 40, and ≥ 40 years of age). No difference in survival curve in the six groups could be detected (P = .6964). Hazard ratio was 0.989 (P = .135; 95% confidence interval [CI], 0.974 to 1.004). Although the difference between groups was not statistically significant, the death probability decreased 0.011 (1 to 0.989) each year of age. Meyers et al3 reported that survival correlated with age in 62 patients of osteosarcoma with clinically detectable pulmonary metastases at initial presentation. However, survival was significantly better for older patients with P = .04. It is interesting that in Professor Briccoli’s patients, survival is better in younger patients and death probability is increased by a factor of .91 for each year of age.In our patients, local recurrence of the primary tumor was reported in a total of 48 patients (17.1%). There was no significant difference in survival curves between these 48 patients and other patients (P = .1394). When the comparison was performed in each group (between the survival of patients who had local recurrence and those who did not), no significant difference could be detected (P = 0.2387 in group 1, 0.7067 in group 2, 0.7698 in group 3, and 0.5912 in group 4, and hazard ratio was 1.299 [P = .1380; 95% CI, 0.919 to 1.837]). However, patients who did not receive surgical excision for local recurrence (n = 15) had a definitely shorter survival (hazard ratio 3.069; P = .0001; 95% CI, 1.721 to 5.475). Local recurrence of the primary lesion might not be the major factor on prognosis in patients who already have pulmonary metastases. Therefore, it is very important to know which is first—local tumor recurrence or lung metastasis—and which patients have both local tumor recurrence and lung metastases simultaneously.Our results seem to agree with the results obtained by Tabone et al,4 who reported on 42 cases of recurrence that occurred in initially nonmetastatic osteosarcoma. The survival rate was better in patients with a local or a pulmonary first recurrence than in patients who had local recurrence to bone, soft tissues, or multiple sites. The most important prognostic indicator at first recurrence was the possibility of complete resection of the disease. In their study, patients not amenable to surgery had a poor prognosis.The reported data in our article, together with this letter, further ensure the need for development of novel therapeutic modalities for treatment of pulmonary metastases from osteosarcoma, other than metastasectomy, to be used in patients who have well-recognized bad prognostic factors.References1. Tsuchyia H, Kanazawa Y, Abdel-Wanis ME, et al: Effect of timing of pulmonary metastases identification on prognosis of patients with osteosarcoma: The Japanese Musculoskeletal Oncology Group Study. J Clin Oncol 20::3470,2002–3477, Link, Google Scholar2. Kandioler D, Kromer E, Tuchler H, et al: Long-term results after repeated surgical removal of pulmonary metastases. Ann Thorac Surg 65::909,1998–912, Crossref, Medline, Google Scholar3. Meyers PA, Heller G, Healey JH, et al: Osteogenic sarcoma with clinically detectable metastasis at initial presentation. J Clin Oncol 11::449,1993–453, Link, Google Scholar4. Tabone MD, Kalifa C, Rodary C, et al: Osteosarcoma recurrences in pediatric patients previously treated with intensive chemotherapy. J Clin Oncol 12::2614,1994–2620, Link, Google Scholar