Pulmonary Surgical Margins for Metastatic Osteosarcoma: Is Negative Margin Enough?

BACKGROUND

In advanced osteosarcoma, the lung is the most frequent site of distant metastasis, with metastasectomy often utilized for local control. The influence of pulmonary resection margin length on outcomes for osteosarcoma has not been well explored. We sought to evaluate the impact of margin length relative to tumor size on local recurrence and survival in lung-limited metastatic osteosarcoma.

METHODS

Patients with metastatic osteosarcoma who underwent lung resection between 2000-2020 were identified from a single institution. Clinicopathologic variables were collected. Margin length-to-tumor size ratio (MTR) was calculated per nodule and classified relative to MTR of 0.5. The primary outcome was development of local recurrence per nodule. Multivariate logistic regression was used to investigate covariates.

RESULTS

142 patients with 689 nodules met inclusion criteria, with mean age of 35.6 years (IQR 20.9-46.6). Patients were predominantly male (n=87, 61.3%) and White (n=106, 72.5%). Most nodules (n=644, 93.5%) were resected via thoracotomy. Mean tumor size was 0.8 cm (IQR 0.5-1.70), with average margin length of 0.3 cm (IQR 0.1-0.7). Among all nodules, 299 (43.4%) had MTR > 0.5. Systemic therapy was received by 94 patients (66.2%) preoperatively and 100 patients (70.4%) postoperatively. Importantly, we found that MTR >0.5 conferred a protective effect against recurrence (HR: 0.67, 95% CI: 0.52-0.87, p=0.003).

CONCLUSIONS

In resected pulmonary metastatic osteosarcoma, margin length greater than half the size of the pulmonary nodule is associated with lower incidence of local recurrence, with implications for subsequent need for additional therapy and disease-free state, meriting attentive intraoperative consideration.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.