Abstract
Bone tumors are neoplasias with a high overall mortality; one of the main factors that reduce survival is their high capacity to develop metastases. It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. In this study, we inquire the relationship of metastases caused by these tumors with different clinical and pathological aspects, in order to guide medical personnel in the diagnosis and opportune treatment of metastases or micro metastases. We collected data of 384 patients with clinical, radiological and histopathological diagnosis of OS, GCTb and CS that attended the National Rehabilitation Institute (INR) during 2006 to 2014. Chi-square and Fisher's exact tests were performed for data analysis. In the three tumor types, the presence of metastases at diagnosis was variable (p=0.0001). Frequency of metastases was 36.7%, 31.7% and 13.2% for OS, CS and GCTb respectively. The average age had no significant difference (p>0.05) in relation to metastases, even so, patients with OS and GCTb and metastases, were older while patients with CS and metastases were younger, in comparison to patients without metastases. Males had a higher frequency of metastases (68.2%, p = 0.09) in contrast to CS and GCTb, in which the metastases was more frequent in women with 51.9% (p = 0.44) and 57.9% (p = 0.56) respectively. Broadly, metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS. The frequency of metastases in OS, GCTb and CS is high in our population and is determined by different clinicopathological variables related to the kind of tumor. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors , as well as to determine the sensitivity and specificity of current methods of detection.
Highlights
The National Institute of Rehabilitation (Mexico City) has reported that OS is the most frequent malignant bone tumor (46.6%) followed by the CS (8.7%) and the most frequent benign bone tumor was giant cell tumor of bone (GCTb) (14.6%), this study were performed during the period of 2000-2005. (Baena-Ocampo et al, 2009; Uribe-Rosales et al, 2014)
Metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS
OS is the most common malignant primary bone tumor; predominantly affecting young people, comprising about 20% of primary bone sarcoma (Huang et al, 2015) of 11% to 20% of patients have detectable metastases at diagnosis, while the percentage of event-free survival at five years is approximately 60% to 70% in patients with localized disease. (Picci, 2007) control of the primary tumor can be achieved with the amputation of the affected limb, since seventies it is known that 80% to 90% of patients relapse with lung metastases at a median of five months after surgery without adjuvant treatment, reflecting that these patients have subclinical metastases or micrometastases at the time of diagnosis undetectable by standard techniques (Martinez-Cedillo, 2012)
Summary
The National Institute of Rehabilitation (Mexico City) has reported that OS is the most frequent malignant bone tumor (46.6%) followed by the CS (8.7%) and the most frequent benign bone tumor was GCTb (14.6%), this study were performed during the period of 2000-2005. National Institute of Pediatrics (Mexico, City) performed an study about this, and they founded that OS had 31% of lung metastases at diagnosis; in other countries, they have been reported frequencies ranging from 30% to 45.7% (Zuniga et al, 2005; Yang et al, 2012; Choeyprasert et al, 2014). It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors , as well as to determine the sensitivity and specificity of current methods of detection
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