Abstract
The aim of this retrospective study was to define clinical and pathological features and prognostic factors among children and adolescents diagnosed with high-grade osteosarcoma of the extremities. A total of 73 patients younger than 18 years diagnosed with primary osteosarcoma of the extremities between January 1998 and December 2013 were retrospectively evaluated. Prognostic factors, such as age, gender, primary tumor site, alkaline phosphatase and lactate dehydrogenase levels, metastatic disease, pathological fracture, histological response, and surgery type, were analyzed to evaluate their effects on overall survival (OS) and event-free survival (EFS). At a median follow-up of 30 months (1.5-152), OS and EFS at 5 years were 64.5 ± 8.1 and 48.5 ± 8.7% for patients with localized disease; and 16.2 ± 7.9 and 14.4 ± 7.3% for patients with initial metastatic disease, respectively. In patients with localized disease, conservative surgery was performed on 22 of 46 patients (43.5%), and there was no significant difference in survival rates among patients who had conservative vs. radical surgery (p = 0.65). Although tumor size (>12 cm) was significant prognostic factor in univariate analysis; multivariate analysis identified elevated levels of alkaline phosphatase (p = 0.033) and poor response to neoadjuvant chemotherapy (p < 0.001) only as independent prognostic factors. Age, histological type, pathological fracture, and primary tumor site did not significantly affect prognosis. Initial elevated presence of alkaline phosphatase in serum and poor histological response after neoadjuvant chemotherapy were significant factors for unfavorable prognosis. It is necessary to optimize staging and treatment intensification to improve survival rates, especially among patients with metastasis at initial presentation.
Highlights
Osteosarcoma is the most frequent malignant bone tumor at pediatric age
Seventy-three patients diagnosed with primary high-grade osteosarcoma of the extremities were retrospectively evaluated
In a systematic revision of prognostic factors for osteosarcoma, it was found that histological response, presence of metastasis, and primary tumor size and site were important prognostic factors [16]
Summary
Osteosarcoma is the most frequent malignant bone tumor at pediatric age. Surgical removal of the tumor remains the most important treatment; survival rates have increased due to the advent of chemotherapy [1,2,3]. Prognostic Factors in Childhood Osteosarcoma localized disease, in spite of complete surgical resection of primary tumor and an intense regimen of chemotherapy [7] These findings reveal an important need to clarify prognostic factors for recurrence or poor survival. Multicenter research studies differ in data collection and therapeutical schemes [10,11,12,13], which makes it difficult to compare and reveals contradictory results. The aim of this retrospective study was to define clinical and pathological features and prognostic factors among children and adolescents diagnosed with highgrade osteosarcoma of the extremities
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
