Abstract
BackgroundThe survival rates of patients with metastatic osteosarcoma are poor, and the prognosis is closely related to the choice of treatment, especially surgery. This study aimed to evaluate the survival outcomes of patients with metastatic osteosarcoma undergoing regional dissections.MethodsWe collected data on patients with metastatic osteosarcoma between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS), while univariate and multivariate Cox regression analyses were used to evaluate outcomes. Propensity score matching (PSM) was used to minimize the effects of confounding factors.ResultsThe SEER database had records of 2768 patients diagnosed with osteosarcoma, of whom 398 were included in our study. Of the included patients, 116 (29.15%) underwent regional dissections, while 282 (70.85%) underwent non-regional dissections. The univariate and multivariate Cox regression analyses, prior to PSM, showed that OS (hazard ratio (HR): 0.34, 95% confidence interval (CI): 0.26–0.44, P<0.001 and HR: 0.47, 95% CI: 0.35–0.64, P<0.001, respectively) and CSS (HR: 0.33, 95% CI: 0.25–0.43, P<0.001 and HR: 0.46, 95% CI: 0.34–0.63, P<0.001, respectively) were better in patients who underwent regional dissections than those who underwent non-regional dissections. Compared with non-regional dissections, regional dissections, which included both primary tumour resection (PTR) and primary tumour and metastatic site resection (PTMR), were associated with better OS (P<0.001) and CSS (P<0.001) . However, the survival outcomes following PTR and PTMR showed no significant difference. After PSM, patients in the regional dissection group still had a higher OS (P<0.001) and CSS (P<0.001) than those in the non-regional dissection group.ConclusionsCompared with non-regional dissection, regional dissection resulted in better survival in patients with metastatic osteosarcoma.
Highlights
Osteosarcoma is the most common primary malignant bone tumour in children and adolescents [1]
While the survival factors associated with metastatic osteosarcoma are complex and controversial, surgical resection is widely accepted as a beneficial treatment
We found that patients in the regional dissection group had better overall survival (OS) (HR: 0.34, 95% confidence interval (CI): 0.26-0.44, P < 0.001) and cancer-specific survival (CSS) (HR: 0.33, 95% CI: 0.250.43, P < 0.001) those in the non-regional dissection group (Table 2)
Summary
Osteosarcoma is the most common primary malignant bone tumour in children and adolescents [1]. It is characterized by rapid progression, early pulmonary metastasis, poor prognosis and recurrence [2,3,4]. The poor prognosis in patients with metastatic osteosarcoma highlights the need for a more effective therapy to treat both primary and metastatic tumours and to improve the patients’ quality of life and survival rates. While the survival factors associated with metastatic osteosarcoma are complex and controversial, surgical resection is widely accepted as a beneficial treatment. The survival rates of patients with metastatic osteosarcoma are poor, and the prognosis is closely related to the choice of treatment, especially surgery. This study aimed to evaluate the survival outcomes of patients with metastatic osteosarcoma undergoing regional dissections
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