Pathologic Fracture In Osteosarcoma Research Articles

Prognostic role of pathologic fracture in osteosarcoma: Evidence based on 1,677 subjects.

The prognostic role of pathologic fracture in osteosarcoma has not been settled down, as previous researches have reached contradictory results. This study is prepared to clarify whether pathologic fracture predicts a poor prognosis of patients with osteosarcoma. After completely retrieved databases including China National Knowledge Infrastructure (CNKI), PubMed, Highwire, EMBASE and Science Direct, all eligible articles were included based on inclusion/exclusion criteria. And we performed a meta-analysis to calculate the pooled prognostic role of pathologic fracture in osteosarcoma. Finally, a total of 8 articles met the inclusion/exclusion criteria, involving 1,677 subjects. We found that the pooled hazard ratios (HRs) with 95% confidential interval (CI) of pathologic fracture in osteosarcoma for overall survival (OS) and disease-free survival (DFS) are 2.13 (1.43, 3.15) and 1.58 (1.11, 2.24), respectively. This meta-analysis demonstrated that presentation with a pathologic fracture in osteosarcoma was correlated with a poor prognosis. And pathologic fracture might be a poor predictor of survival in osteosarcoma.

Clinical and functional outcomes of patients with a pathologic fracture in high‐grade osteosarcoma

There have been variable reports of outcomes of patients with osteosarcoma and pathologic fractures. The purpose of this study was to document outcomes after management of this clinical entity at a single large oncology center. A retrospective review was undertaken of our database between 1989 and 2006. We compared oncologic and functional outcomes of 201 patients with high-grade osteosarcoma without pathologic fractures to 31 patients with pathologic fractures. The rate of amputation in the group with pathologic fracture was significantly higher than the group without fracture (39% vs. 14%, P = 0.001). There was no difference in the rate of local recurrence between groups. The 5-year survival was superior in the group without pathologic fracture (60% vs. 41%, P = 0.0015). For patients with localized disease, 5-year survival was higher in patients without fracture (68% vs. 52%, P = 0.006). Disability as measured by the Toronto Extremity Salvage Score was no different between the groups. Impairment as measured by the Musculoskeletal Tumor Society scores was lower in the group without fracture. Presentation with a pathologic fracture in osteosarcoma did not preclude limb salvage surgery in a majority of patients, did not increase the risk of local recurrence, but was associated with poorer overall survival.

Prognostic effect of pathologic fracture in localized osteosarcoma: A cohort/case controlled study at a single institute

The negative prognostic role of pathologic fracture in osteosarcoma is not determined, as previous case-control and retrospective cohort studies have produced contradictory results. We conducted both cohort (n = 384) and case-control (n = 111) studies on 37 pathologically fractured localized osteosarcoma of extremity. In cohort study, patients with a fracture showed a tendency of poorer survival, but the difference did not reach the level of significance (5-year metastasis-free survival rates; 48% for cases vs. 61% for controls; P = 0.06). A case-control study on 37 fractured and 74 control recruited from 347 patients matched for tumor size and location showed no survival difference between the cases and controls (P = 0.12). Reported negative prognostic effect of a pathologic fracture is likely to be due to confounding by tumor size and location. The present study suggests that the presence of a pathologic fracture has no prognostic relevance.

The Surgical Treatment of Patients With Osteosarcoma Who Sustain a Pathologic Fracture

The presence of pathologic fracture in osteosarcoma raises concerns of tumor dissemination by the fracture hematoma and has been considered a contraindication to limb salvage surgery. Because this is a theoretical concern, there are little clinical data available in the literature on which to base treatment of these patients. Eighteen patients with osteosarcoma who sustained a pathologic fracture and had a minimum of 24 months of followup were reviewed retrospectively. Surgical treatment included nonoperative therapy, amputation, and limb salvage groups. Patients who refused surgical intervention (2) had a uniformly poor outcome. Patients who underwent amputation (6) had no local recurrences and 33% developed metastases. Patients who underwent limb salvage (10) experienced 3 local recurrences and 6 distant recurrences. Although the distant recurrence rate for patients undergoing amputation was no different from the rate for those undergoing limb salvage, the difference in local tumor control approached statistical significance. All patients who developed local recurrence died. Surgical treatment needs to be individualized and based on factors such as fracture displacement, stability, radiographic and histologic response to chemotherapy, and the perceived ability to resect the fracture hematoma completely.