Prognostic significance of chemotherapy-induced necrosis in osteosarcoma patients receiving pasteurized autografts.

Min Wook Joo,Yong Koo Kang,Chang-Young Yoo,Yang-Guk Chung,Sung Ho Cha,Marta M Alonso

doi:10.1371/journal.pone.0172155

Abstract

BackgroundAmong various reconstruction methods after wide excision for osteosarcoma, pasteurized autograft is often preferred. While the whole area of the tumor can be assessed for chemotherapy-induced necrosis, one of the important prognostic factors, in other reconstructive techniques, only a portion removed from a wide-resection specimen is available when using pasteurized autograft method. The assessment, therefore, may be unreliable. We analyzed the prognostic significance of the chemotherapy-induced necrosis in osteosarcoma patients who underwent reconstruction with pasteurized autografts.Patients and methodsWe reviewed the records of osteosarcoma patients who underwent treatment in our institution from 1998 to 2013. Cases of reconstruction with pasteurized autografts were defined as the patient group, and the same number of patients who underwent other reconstruction methods served as controls. Chemotherapy-induced necrosis was evaluated for removed extra-osseous and curetted intramedullary tumor tissues.ResultsA total of 22 patients were identified; the median age was 15.5 years, and there were 12 males. The most common tumor location was the distal femur. The most common histological subtype was osteoblastic. Median size was 8.1 cm. Disease status was stage IIB in 13 patients and IIA in 9. Median follow-up was 76 months. No differences between the patient and control groups were observed in potential prognostic factors, overall survival, metastasis-free survival, or recurrence-free survival. Univariate analyses demonstrated that histological response was a significant prognostic factor for metastasis-free survival and also significant for recurrence-free survival.ConclusionChemotherapy-induced necrosis grading, using only available tumor tissues, could be a prognostic factor for osteosarcoma patients receiving pasteurized autografts for reconstructive surgery.

Highlights

Before the introduction of chemotherapy, nearly 90% of patients with osteosarcoma developed distant metastases, and died of their disease despite the standard treatment at the time, limb amputation [1,2]
We reviewed the records of osteosarcoma patients who underwent treatment in our institution from 1998 to 2013
Cases of reconstruction with pasteurized autografts were defined as the patient group, and the same number of patients who underwent other reconstruction methods served as controls

Summary

Introduction

Before the introduction of chemotherapy, nearly 90% of patients with osteosarcoma developed distant metastases, and died of their disease despite the standard treatment at the time, limb amputation [1,2]. Even though multidisciplinary treatment with pre- and post-operative chemotherapy and wide resection has improved clinical outcomes since the late twentieth century, the 5-year overall survival (OS) rate remains around 60%, and local recurrence and metastasis are not infrequent after completion of initial treatment [3,4,5]. Among various reconstruction methods after wide excision for osteosarcoma, pasteurized autograft is often preferred. While the whole area of the tumor can be assessed for chemotherapy-induced necrosis, one of the important prognostic factors, in other reconstructive techniques, only a portion removed from a wide-resection specimen is available when using pasteurized autograft method. We analyzed the prognostic significance of the chemotherapy-induced necrosis in osteosarcoma patients who underwent reconstruction with pasteurized autografts

Results

Discussion

Conclusion