Physeal breach as a potential predictor of pulmonary metastasis in paediatric osteosarcoma
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By
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Zichen Lin
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Peng Huang
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Jing Shan
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Zhi Qi
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Miaoyang Liang
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Bixuan Cao
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Bo Ning
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May 5, 2026
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Clinical Scorecard: Physeal Disruption as a Possible Indicator of Lung Metastasis in Pediatric Osteosarcoma
At a Glance
| Category | Detail |
|---|
| Condition | Pediatric Osteosarcoma |
| Key Mechanisms | Physeal breach as a predictor of pulmonary metastasis; angiogenic activity at the tumor–physis interface. |
| Target Population | Pediatric and adolescent patients (≤18 years) with histologically confirmed long-bone osteosarcoma. |
| Care Setting | Single-centre, retrospective cohort study. |
Key Highlights
- Pulmonary metastases increased from 22% at diagnosis to 50% by last follow-up.
- Physeal breach was the only independent predictor of metastasis (odds ratio 59.89).
- All physeal-breach mice developed pulmonary metastases in the xenograft model.
- VEGF immunohistochemistry showed increased angiogenic activity in breach-associated tumors.
- Physeal breach may serve as a practical biomarker for risk stratification.
Guideline-Based Recommendations
Diagnosis
- Evaluate physeal breach using routine imaging post-chemotherapy.
Management
- Consider anti-angiogenic strategies for patients with physeal breach.
Monitoring & Follow-up
- Regular imaging to assess for pulmonary metastasis in patients with physeal breach.
Risks
- Increased risk of pulmonary metastasis associated with physeal breach.
Patient & Prescribing Data
32 pediatric osteosarcoma patients receiving neoadjuvant chemotherapy.
Physeal breach status should be integrated into treatment planning and risk assessment.
Clinical Best Practices
- Incorporate physeal breach evaluation in routine imaging protocols.
- Utilize VEGF levels as a potential marker for tumor aggressiveness.
References
