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Ann Thorac Surg 1984;38:473-478
© 1984 The Society of Thoracic Surgeons

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Articles

The Influence of Tumor Microfoci on Recurrence and Survival Following Pulmonary Resection of Metastatic Osteogenic Sarcoma

Section of Pediatric Surgery and Department of Pediatrics, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI.

¹ Address reprint requests to Dr. Coran, F7516 Mott Children's Hospital, Box 66, Ann Arbor, MI 48109.

Factors that influence recurrence and survival following thoracotomy for metastatic osteogenic sarcoma are not well defined. We examined the clinical and pathological material from 51 patients who had no metastases at the time of operative treatment of osteogenic sarcoma at the University of Michigan from 1962 to 1982. Ages ranged from 2 to 30 years (mean, 15 years). Metastases developed in 37 patients (72.5%) at a mean of 8 months after initial operation. Thirteen patients were treated with chemotherapy only; 12 of them died after a mean survival of 7 months. Twenty-four patients were treated with chemotherapy and 45 thoracotomies (mean, 1.9 per patient-range, 1 to 5) during which 120 wedge resections or lobectomies were performed. Follow-up is available on 22 of these 24 patients, 11 (50%) of whom are alive (9, tumor free) at a mean of 51 months after thoracotomy. Eleven patients died after a mean survival of 27 months p 0.001 compared with the group having chemotherapy only).

Microfoci of tumor (tumor cells separate from the gross tumor nodule) were found in resection specimens in 12 patients at the first thoracotomy; in 11 of these 12 patients, new metastases subsequently developed resulting in 10 reoperations. Twelve patients had no microfoci at the first operation; new metastases developed in 5; 3 underwent reoperation. Overall, microfoci were found at 29 operations; in patients with this finding, new metastases developed twenty-seven times (93%). New metastases developed in patients with microfoci at a mean of 5 months versus a 12-month recurrence rate in patients without this finding (p 0.01). Six (67%) of 9 tumor-free survivors were without microfoci at operation, whereas 9 (82%) of the 11 patients who died had microfoci found at 1 or more operations.

We conclude that the presence of micrometastases in the specimen obtained at pulmonary resection predicts a high rate of early and frequent recurrence of pulmonary metastases and low survival. Patients with this finding require more frequent follow-up and aggressive therapy. Despite the high rate of recurrence, aggressive pulmonary resection substantially prolongs survival compared with patients treated without operation. Therefore, the presence of microfoci should not preclude subsequent chemotherapy or surgical therapy.

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