A multi-center retrospective analysis of clinical prognosis in children with extremity osteosarcoma

Abstract

Objective To explore the relevant influencing factors of clinical prognosis of children aged ≤14 years with extremity osteosarcoma. Methods A retrospective analysis was performed for medical records of children aged ≤14 years with extremity osteosarcoma admitted into seven bone cancer treatment centers in China from June 2000 to October 2017.The general data, surgical stage, preoperative biopsy, regimen/number of chemotherapy, surgical approach, recurrence, metastasis and survival prognosis were recorded.A Kaplan-Meier method was employed for plotting survival curve and calculating survival rate.A log-rank analysis was performed for determining the prognostic factors related to survival rate.And Cox model multivariate analysis was employed for identifying independent prognostic factors. Results There were 73 boys and 74 girls.They had a 3- and 5- year overall survival rates of 65% and 53%, with a median overall survival of 103 months (95%CI: 92.8 to 128.5), a 3/5-year disease-free survival rates of 46% and 38% and a median disease-free survival of 33 months (95%CI: 71.9 to 104.3). They were around knee joint (n=123) and outside knee joint (n=24). The Enneking surgical stage was Ⅱ (n=139) and Ⅲ (n=8). There were extremity salvage (n=128) and amputation (n=19). The chemotherapy was standard (n=78) and non-standard (n=69). The 5-year overall survival rates of standard and non-standard chemotherapy groups were 62% and 43.8% respectively.The 5-year disease-free survival rates were 50.2% and 31.6% respectively.There were no recurrence or metastasis (n=75), simple recurrence (n=13), simple metastasis (n=41) and multiple metastases (n=18, including recurrence & metastasis). The 5-year overall survival rate was 88%, 51.3%, 21.4% and 0 respectively.Univariate analysis showed that standard chemotherapy, Enneking surgical stage, frequency of postoperative adjuvant chemotherapy, recurrence and metastasis were the relevant influencing factors of survival and prognosis of children with extremity osteosarcoma (P 0.05). Cox regression multivariate analysis showed that standard chemotherapy, recurrence and metastasis were independent influencing factors of survival and prognosis of children with extremity osteosarcoma (P<0.05). Conclusions Standard neoadjuvant chemotherapy and effective control of recurrence and metastasis can improve the survival rate and prognosis of children with extremity osteosarcoma.Non-standard chemotherapy .Recurrence and metastasis adversely affect the prognosis of patients. Key words: Osteosarcoma; Limb; Child; Multicenter study; Prognosis