Review Article Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients Gehad Ahmed a, b, ⁎, Manal Zamzam c, g , Ahmed Kamel c, g , Sonia Ahmed c, g , Asmaa Salama d, g , Iman Zaki e, g , Nehal Kamal f , Maged Elshafiey b, g a Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt b Surgical Oncology Department, Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt c Pediatric Oncology Department, CCHE, Cairo, Egypt d Pathology Department, CCHE, Cairo, Egypt e Radiodiagnosis Department, CCHE, Cairo, Egypt f Clinical Research Department, CCHE, Cairo, Egypt g National Cancer Institute, Cairo University, Cairo, Egypt abstract article info Article history: Received 27 February 2018 Received in revised form 16 May 2018 Accepted 13 June 2018 Available online xxxx Key words: Metastasectomy Osteosarcoma Prognosis 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 chemother- apy (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 b 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. Level of evidence: Level II. © 2018 Elsevier Inc. All rights reserved. Contents 1. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 The lung is the most common site for osteosarcoma metastasis. Lung metastases are detectable in approximately 20% of patients with osteosarcoma at initial presentation [1, 2] whereas roughly 50% will develop lung metastases during or after treatment [3, 4]. Journal of Pediatric Surgery xxx (2018) xxx–xxx ⁎ Corresponding author at: Department of Surgery, Faculty of Medicine, Helwan Uni- versity, Ain Helwan, Helwan, Cairo 11795, Egypt. Tel.: +20 1227268865. E-mail address: gehad.taha@gmail.com (G. Ahmed). YJPSU-58726; No of Pages 5 https://doi.org/10.1016/j.jpedsurg.2018.06.019 0022-3468/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Ahmed G, et al, Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients, J Pediatr Surg (2018), https://doi.org/10.1016/j.jpedsurg.2018.06.019