Abstract
ObjectiveWith the development of osteosarcoma treatment, limb salvage surgery is gradually replacing amputation as the primary surgical option. Most pediatric osteosarcomas of the limbs undergo limb-salvage surgery. We aimed to use propensity score matching (PSM) analysis test the difference in cancer-specific mortality (CSM) between amputation and limb-salvage surgery in pediatric patients with Osteosarcoma of the limbs. PSM is a statistical method used to deal with data from an Observational Study. The PSM method is designed to reduce the influence of biases and confounding variables to make a more reasonable comparison between experimental and control groups.MethodsPatient information was downloaded from the SEER (surveillance, epidemiology, and End Results) database from 2004 to 2018. We included all primary pediatric osteosarcoma patients who underwent limb salvage or amputation. Multivariate logistic regression models were used to explore the factors influencing patient choice of amputation. Differences in CSM and other causes of mortality (OSM) between limb salvage and amputation were analyzed using cumulative incidence plots and competitive risk regression tests after 1:1 proportional propensity score matching.ResultsA total of 1,058 pediatric patients with limbs Osteosarcoma were included. Patients who underwent amputations were more likely to be male (OR 1.4, P = 0.024) and more likely to have distant metastasis (OR 2.1, P < 0.001). Before propensity matching, CSM was 1.4 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.017) and 3.4 times higher in OSM (P = 0.007). After adjustment for propensity matching, CSM was 1.5 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.028), but there was no significant difference in OSM (HR 3.2, P = 0.078).ConclusionsOur results suggested that amputation is associated with a 1.5-fold increase in CSM in pediatric patients with limbs Osteosarcoma. Therefore, in the surgical selection of pediatric patients with Osteosarcoma, limb salvage surgery should be the first choice in the absence of other contraindications.
Highlights
Osteosarcoma is the most common bone malignancy in children and young adults [1]
We found that the predictors of patient choice for amputation were male, other races, and distant metastasis
The comparison between amputation and limb-salvage surgery was first studied by Simon et al on 227 patients with Osteosarcoma and found that limb salvage surgery did not significantly improve the survival rate of patients [24]
Summary
Osteosarcoma is the most common bone malignancy in children and young adults [1]. Another study found Osteosarcoma in 2–3 per million in all populations and 8– 11 per million in people aged 15–19 years [3]. Osteosarcomas peak mainly during adolescence between the ages of 10 and 14, with another peak after 80 [4]. Osteosarcomas often occur in the metaphysis of long bones, mainly in the lower limbs. Progression of Osteosarcoma is associated with rapid bone growth during adolescence [5]. The treatment of Osteosarcoma has improved over the past 20 years, including neoadjuvant chemotherapy and radiotherapy, but the overall prognosis of Osteosarcoma remains poor [8,9,10]. Osteosarcoma is one of the health hazards in children, accounting for 8.9% of childhood cancer-related deaths. The 5year survival rate for Osteosarcoma without distant metastasis is 65 to 70% [11], but only 19 to 30% for Osteosarcoma with distant metastasis [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
