Prognostic Factors in the Survival of Patients Diagnosed with Primary Non-Metastatic Osteosarcoma with a Poor Response to Neoadjuvant Chemotherapy

Abstract

INTRODUCTION:Identification of variables that determine the prognosis for osteosarcoma may enable stratification of patients into subgroups with better or worse risk of local recurrence, metastases and death due to the disease. Discovery of such prognostic factors would permit selection of a subgroup of at-risk patients, with the aim of improving the therapeutic effectiveness.OBJECTIVE:To identify prognostic factors related to local recurrence-free survival, metastasis-free survival and overall survival among patients with highly malignant primary osteosarcoma that was non-metastatic on diagnosis and had poor response to neoadjuvant chemotherapy.SAMPLE AND METHODS:Out of 45 patients admitted to a referral center in Brazil between 2000 and 2004, 24 were selected for this study.RESULTS:The adverse factors that influenced the risk of local recurrence and the overall survival in univariate analysis were histological subtype other than osteoblastic (p = 0.017) and tumor size greater than 15 cm (p = 0.048). In relation to metastasis-free survival, the non-osteoblastic subtype had a worse prognosis (p = 0.007). The association of histological subtype maintained its significance in multivariate analysis for all studied survival categories.CONCLUSIONS:Tumor size greater than 15 cm is an adverse factor for local recurrence-free survival and overall survival but did not influence metastasis-free survival. The osteosarcoma histological type is a significant independent predictor for local recurrence-free survival, metastasis-free survival and overall survival.

Impact of close surgical margin on local recurrence and survival in osteosarcoma

“…The best margin width for osteosarcoma is still unclear and remains controversial. In one study including 837 patients, the safe margin was advised as 2 cm wide when the preoperative modality is effective [12], but another earlier study failed to detect the difference in LR between margins less than 2 mm and greater than 2 mm in osteosarcoma patients [13]. Several studies have shown that histological response to chemotherapy was closely associated with LR [4,5,7,8], but other studies did not confirm this [3,6,9,14].…”

Existe diferença no prognóstico de pacientes com osteossarcoma primário com uma pobre resposta à quimioterapia neoadjuvante entre os graus I e II de huvos?

“…Despite the relative rarity of osteosarcoma, several studies (7,12,(15)(16)(17)20,21,(24)(25)(26)(27) , including some within our setting, have sought to identify risk factors that might influence the natural history of this tumor and the prognosis for patients.…”

CORR Insights®: Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?

“…A previous study compared margins of greater than 5 mm to those of less than 5 mm. An additional study also compared margins of greater than 2 mm and less than 2 mm with neither study showing an increase in local recurrence [2,4].…”