Influence of prognostic factors in pediatric high-grade osteosarcoma survival.

Abstract

9572 Background: Some others prognostic factors are interrelated with the well-known prognostic factors in high-grade Osteosarcoma (HGO), this can result in poor survival and should be considered for appropriate clinical decision making. Methods: Retrospective, longitudinal and clinical study was performed from Jan/1991-Dec/1998, 58 patients younger than 18 years with extremity HGO and no prior chemotherapy treatment were included. All received CDDP, DOX, CFA and VP-16. Prognostic-factors and Cox analysis with odds-ratio (OR) and p<0.05 were calculated. Outcome variables were age, histologic patterns (HP), primary site, tumor size (TS), metastatic disease, soft-tissue involvement (STI), histological response (HR) assessed by Huvos-grades and disease-free survival (DFS). Results: Median age was 12 years (5-18y) with 18 patients (31%) younger than 10 years. Skeletal site (SS) distribution was 59% distal femur, 17% proximal humerus, 14% proximal tibia, 7% fibula and 3% proximal femur. 18 patients (31%) had pulmonary metastases and 3 patients (5%) had multifocal disease at diagnosis. There were 74% osteoblastic tumors, 14% osteoblastic and chondroblastic, and 5% chondroblastic. 15 patients had an amputation procedure and 33 patients undergoing limb salvage of which 5 patients (15%) had eventual local recurrence. The more significant associated prognostic factors (APF) for local recurrence were STI at diagnosis (OR=6), grade-II HR (OR=2.8), grade-III HR (OR=10), TS (p0.0350) and chondroblastic-HP (p0.0089). For amputation procedures were SS (p0.0018) and have microscopic surgical margins (MSM) p0.0075. For development of metastatic disease were TS (p0.0008), MSM (p0.000), pulmonary metastases at diagnosis (p0.000), SS (p0.000) and chondroblastic-HP (p0.000). For death by tumor activity was poor in HR (p0.0013) and TS (p0.0278). 5-years DFS without APF was 68% Vs 43% with APF (p0.021). Conclusions: APF play a very important roll in Osteosarcoma prognosis and should be considered for appropriate clinical decisions making.