Abstract
BackgroundOsteosarcoma is one of the most malignant primary bone cancers, while is rarely reported in China. Of note, very few data of prognosis has been documented in this region. Thus, we carried a retrospective study to identify prognostic factors and to analyze outcomes in patients of both classic and non-classic high-grade osteosarcomas. Classic osteosarcoma is defined as of high-grade histology, age below 40 years, with extremity localized primary tumor, and without detectable metastasis at primary diagnosis.MethodsA total of 98 patients (68 classic and 30 non-classic) aged from 4 to 64 years old were diagnosed as high-grade osteosarcoma from 2008 to 2015 in Nanfang Hospital, Guangzhou, China. Univariate and multivariate analyses were performed to identify the independent predictors for overall survival and event-free survival. Kaplan-Meier method was used for survival analysis.ResultsThe median overall survival was 117 vs. 21 months, and the median event-free survival was 31 vs. 6 months in classic and non-classic osteosarcoma, respectively. The most frequently found tumor site was around the knee. The classic osteosarcoma had better overall survival and event-free survival than the non-classics. Tumor site and primary metastasis were found to be associated with overall survival and event-free survival in the univariate analysis. In the multivariate Cox regression analysis, tumor site and primary metastasis were each verified as independent prognostic factors. However, no similar result was found in elevated serum alkaline phosphatase or lactate dehydrogenase. Amputation or limb salvage surgery had no significant effect on overall survival and event-free survival in the extremity osteosarcomas. Classic osteosarcomas with extremity tumor site and free of primary metastasis exhibited better overall survival and event-free survival, while the axial and metastatic non-classics exhibited the worse.ConclusionsThe extremity classic osteosarcomas have better survivals than the axial non-classic cases. Amputation and limb salvage surgery make no significant change in overall survival and event-free survival in the extremity osteosarcomas.Trial registrationNanfang2013071; Date of registration: 7 September 2013 (retrospectively registered).
Highlights
Osteosarcoma is one of the most malignant primary bone cancers, while is rarely reported in China
The aim of this study is to find out the prognostic factors of osteosarcoma and to analyze the overall survival (OS) and event-free survival (EFS) in different patient subgroups
Since all included patients were of high-grade differentiation, no great histological difference was found between the classic osteosarcoma and the non-classics in this study (Fig. 1a)
Summary
Osteosarcoma is one of the most malignant primary bone cancers, while is rarely reported in China. The incidence rate is rare in China with only about 3 per million persons every year This fact is probably the reason why few data of Advances in the clinical management of osteosarcoma, the introduction of multiagent chemotherapy in combination with surgery, had led to dramatic prognostic improvements in 5-year survival rates from less than 20% to 55–80% in the 1980s [1, 2]. Lin et al World Journal of Surgical Oncology (2018) 16:39 achieved in the last 30 years [6], and there are still controversies in some aspects concerning prognostic evaluation and therapeutic approaches [2, 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. The “non-classic osteosarcoma” was defined as primary metastatic disease, non-extremity localization, or age > 40 years [22]
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