Abstract
Osteosarcoma is a leading cause of malignant tumor related death. We conducted a meta-analysis to evaluate the association between pathological fractures and prognosis in patients with osteosarcoma. We searched PubMed, Web of Science, and Embase for studies published until May 15, 2017. Crude and adjusted relative risk (RR) with 95% confidence intervals were used to compare data between the case and control groups. Fourteen studies and 3910 patients were included in the final meta-analysis. No statistically significant difference was detected between the pathological fracture and non-pathological fracture groups in local recurrences analysis (RR = 1.102, 95% CI: 0.813–1.495, P = 0.531); however, a statistically significant difference was found between group in distant metastasis (RR = 1.424, 95% CI: 1.089–1.862, P = 0.01). For survival rates, the following RRs were calculated: 3-year overall survival (OS) (RR = 0.736, 95% CI: 0.593–0.912, P = 0.005); 5-year OS (RR = 0.889, 95% CI: 0.791–0.999, P = 0.049); 3-year event-free survival (EFS) (RR = 0.812, 95% CI: 0.682–0.966, P = 0.018); and 5-year EFS (RR = 0.876, 95% CI: 0.785–0.978, P = 0.019). The pooled estimate of RR was 0.673 (95% CI: 0.364–1.244, P = 0.206) for local recurrence in the amputation and limb salvage groups. In conclusion, our analysis indicated that there were no differences in local recurrence and local recurrence after limb salvage between patients with or without a fracture. Additionally, the patients with pathological fracture had a higher risk of distant metastasis and lower 3-year OS, 5-year OS, 3-year EFS, and 5-year EFS. Considering the limitations of this study, we believe that future large-scale studies should be performed to confirm our conclusions.
Highlights
Osteosarcoma, the most common primary malignancy of bone, is a leading cause of malignant tumor related death in children and adolescents [1]
There are several studies which have assessed the association between pathological fracture and prognosis in patients with osteosarcoma; the results were inconclusive because of the limited sample of single-study
We used a pooled meta-analysis of current published studies to further evaluate the association between pathological fracture and prognosis in patients with osteosarcoma
Summary
Osteosarcoma, the most common primary malignancy of bone, is a leading cause of malignant tumor related death in children and adolescents [1]. In the USA, nearly 850 new cases are diagnosed each year, and about 400 cases arise in children and adolescents ≤ 20 years old [2]. More than 20% of cases involve pulmonary metastasis when they are diagnosed as osteosarcoma, which frequently results in patient death [3]. Due to frequent lung metastasis, the prognosis for osteosarcoma is poor [4]. The usual treatment for osteosarcoma www.impactjournals.com/oncotarget is complete radical, surgical, en bloc resection with adjuvant chemotherapy after operation or neoadjuvant chemotherapy before surgical resection of the primary tumor [5]. More than 30% of patients show recurrence or metastatic disease in the first 5 years after diagnosis [6]
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