Abstract
Background:Pediatric osteosarcoma outcomes among developed and developing countries have not been previously compared. Countries in Southeast Asia (SEA) have a wide variety of socioeconomic statuses. A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. Methods:Pediatric patients with osteosarcoma treated between 1998 and 2017 in 4 SEA pediatric oncology centers were studied. Countries were classified using the World Bank Atlas method. Kaplan–Meier method and Cox’s Proportion Hazard Model were applied to estimate survival outcomes and identify prognostic factors. Results:In all, 149 patients with osteosarcoma with a mean age of 12.48±3.66 years were enrolled. The localized to metastatic disease ratio was 1.5:1. The 5-year overall survival (OS) and event-free survival (EFS) were 53.8% and 42%, respectively. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value <0.05). In patients with localized disease, EFS was superior with limb-salvage surgery (62%) than amputation or rotationplasty (40%) (p-value 0.009). MTX-containing chemotherapies provided higher OS (45.3%) and EFS (37.9%) than non-MTX regimens (12.3% and 10.7%, respectively) among metastatic patients (p-value 0.004 and 0.005, respectively). Metastatic disease was an independent prognostic factor for death but not relapse outcome. Conclusion:The disease outcomes in SEA were acceptable compared to developed countries. The stage of disease was the only independent prognostic factor. MTX-containing regimens and limb-salvage surgery should be considered where possible.
Highlights
Osteosarcoma is the most common primary malignant bone tumor among children and adolescents (Mirabello et al, 2009)
Among 149 patients with osteosarcoma enrolled in this study, 33 (22.1%) patients were from Thailand (UMIC), 54 (36.2%) patients from the Philippines (LMIC), and 62 (41.6%) patients from Singapore (HIC)
Patient characteristics including the age of diagnosis, Maximal tumor diameter (MTD), primary sites, stage, sites of metastasis, chemotherapies, and surgery were analyzed according to the countries (Table 1)
Summary
Osteosarcoma is the most common primary malignant bone tumor among children and adolescents (Mirabello et al, 2009). Established prognostic factors include primary sites and size of tumors, surgery (Fu et al, 2020), metastatic. Standard treatment for pediatric osteosarcoma in developed countries includes neoadjuvant methotrexate (MTX)-based chemotherapy followed by surgical control and subsequently adjuvant chemotherapy with desirable outcomes (Marina et al, 2016). A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value
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