Outcomes of Pulmonary Metastasectomy for Pediatric Sarcoma

Abstract

Objective: To evaluate survival outcomes and prognostic factors among pediatric patients with pulmonary metastatic sarcoma who underwent pulmonary metastasectomy at Ramathibodi Hospital. Materials and Methods: The present study was a retrospective study that included pediatric patients younger than 20 years diagnosed with pulmonary metastatic sarcoma and who underwent surgical resection between January 2007 and December 2019. Demographic, clinical, and operative data were collected from electronic medical records. Survival was analyzed using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox proportional hazards model. Results: Twenty-seven patients were included, with a mean age of 12.2±4.4 years and with 70.4% male. Osteosarcoma was the most common primary tumor at 66.7%. The majority (77.8%) underwent posterolateral thoracotomy, and 70.4% had wedge resection. Complete resection was achieved in 66.7% of cases. The median overall survival was 13 months, with 3-year and 5-year survival rates of 33.6% and 12.6%, respectively. The median recurrence-free interval was 8.6 months. Disease recurrence occurred in 63% of patients and was the only variable significantly associated with mortality (p=0.047). In the Cox regression analysis, older age was the only factor significantly associated with recurrence (HR 1.12, 95% CI 1.00 to 1.30, p=0.046). All long-term survivors had osteosarcoma as the primary tumor. Conclusion: Pulmonary metastasectomy offers a potential survival benefit in pediatric patients with pulmonary metastatic sarcoma. Age at the time of surgery was a significant risk factor of recurrence, whereas surgical approach and extent of resection did not affect outcomes. Osteosarcoma was associated with a trend toward improved survival, though not statistically significant. Further multicenter studies with larger cohorts are warranted to validate these findings and optimize surgical strategies for this challenging patient population.