Abstract
Simple SummaryAge is one of many prognostic factors for overall survival in patients with skeletal osteosarcoma. This retrospective study provides an overview of survival in patients with high-grade osteosarcoma in different age groups. It shows prognostic variables for survival and local control among the overall cohort. In this study, in which 402 patients with skeletal high-grade osteosarcoma were included, poor survival was associated with increasing age. Age groups, tumor size, poor histopathological response, distant metastasis at presentation, and local recurrence were independent prognostic factors associated to overall survival and event-free survival. Differences in outcome among different age groups can be partially explained by patient characteristics and treatment characteristics.Age is a known prognostic factor for many sarcoma subtypes, however in the literature there are limited data on the different risk profiles of different age groups for osteosarcoma survival. This study aims to provide an overview of survival in patients with high-grade osteosarcoma in different age groups and prognostic variables for survival and local control among the entire cohort. In this single center retrospective cohort study, 402 patients with skeletal high-grade osteosarcoma were diagnosed and treated with curative intent between 1978 and 2017 at the Leiden University Medical Center (LUMC). Prognostic factors for survival were analyzed using a Cox proportional hazard model. In this study poor overall survival (OS) and event-free survival (EFS) were associated with increasing age. Age groups, tumor size, poor histopathological response, distant metastasis (DM) at presentation and local recurrence (LR) were important independent prognostic factors influencing OS and EFS. Differences in outcome among different age groups can be partially explained by patient and treatment characteristics.
Highlights
High-grade conventional osteosarcoma is a primary malignant bone tumor that has a bimodal distribution curve
Among 501 patients with high-grade osteosarcoma, 84 patients were not treated were excluded because primary tumor was located facially orand extra-skeletally
After 40 years ofadjuvant chemotherapy for osteosarcoma, whose benefits in terms of survival are well established but have not improved, this paper clearly shows that it is time to change the approach and consider additional therapeutic options
Summary
High-grade conventional osteosarcoma is a primary malignant bone tumor that has a bimodal distribution curve. 3–4 cases per million per year [3,4]), osteosarcoma is the most common primary malignant bone tumor. It continues to be a high risk malignancy and has one of the highest mortality rates of any type of cancer diagnosed around puberty [5]. Before the introduction of chemotherapy in the 1980’s, survival for patients with high-grade osteosarcoma was poor with survival probabilities as low as less than 20% [3]. After the introduction of chemotherapy, the overall survival (OS) increased to an average of 60% [3,6,7]
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