Amputation Predisposes to Higher Cancer-Specific Mortality Than Limb Salvage Surgery in Pediatric Patients With Osteosarcoma of the Limbs: A Propensity Matching Analysis

Abstract

ObjectiveWith the development of osteosarcoma treatment, limb salvage surgery is gradually replacing amputation as the primary surgical option. Most pediatric osteosarcomas of the limbs undergo limb-salvage surgery. We aimed to use propensity score matching (PSM) analysis test the difference in cancer-specific mortality (CSM) between amputation and limb-salvage surgery in pediatric patients with Osteosarcoma of the limbs. PSM is a statistical method used to deal with data from an Observational Study. The PSM method is designed to reduce the influence of biases and confounding variables to make a more reasonable comparison between experimental and control groups.MethodsPatient information was downloaded from the SEER (surveillance, epidemiology, and End Results) database from 2004 to 2018. We included all primary pediatric osteosarcoma patients who underwent limb salvage or amputation. Multivariate logistic regression models were used to explore the factors influencing patient choice of amputation. Differences in CSM and other causes of mortality (OSM) between limb salvage and amputation were analyzed using cumulative incidence plots and competitive risk regression tests after 1:1 proportional propensity score matching.ResultsA total of 1,058 pediatric patients with limbs Osteosarcoma were included. Patients who underwent amputations were more likely to be male (OR 1.4, P = 0.024) and more likely to have distant metastasis (OR 2.1, P < 0.001). Before propensity matching, CSM was 1.4 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.017) and 3.4 times higher in OSM (P = 0.007). After adjustment for propensity matching, CSM was 1.5 times higher in patients undergoing amputation than in patients undergoing limb salvage (P = 0.028), but there was no significant difference in OSM (HR 3.2, P = 0.078).ConclusionsOur results suggested that amputation is associated with a 1.5-fold increase in CSM in pediatric patients with limbs Osteosarcoma. Therefore, in the surgical selection of pediatric patients with Osteosarcoma, limb salvage surgery should be the first choice in the absence of other contraindications.

Risk stratification system and web-based nomogram constructed for predicting the overall survival of primary osteosarcoma patients after surgical resection

“…These nomograms either did not incorporate the surgery-related variable or failed to distinguish between the impact of various surgical methods on survival. Prior surgery-related research for osteosarcoma has only identified survival risk factors after amputation or compared survival rates between amputation patients and limbsalvage patients (14)(15)(16)34). Still, they have failed to differentiate between local and radical resection and have not presented reliable postoperative prognostic models.…”

“…Salvage surgery has been more advanced in recent years thanks to advancements in adjuvant chemotherapy research, high-intensity focused ultrasound ablation (HIFU), and computer-aided navigation systems (CANS) (10). However, although both local resection and radical resection are considered salvage surgeries, previous studies have failed to distinguish between the two or develop an effective postoperative predictive model for osteosarcoma patients (11)(12)(13)(14)(15)(16).…”

“…Previous prognostic nomograms for osteosarcoma have reported that age, sex, tumor size, primary site, grade, disease stage, AJCC stage, surgery, chemotherapy, radiotherapy, distant metastasis, and so on were associated with prognostic survival (11)(12)(13)(14)(15)(16)(20)(21)(22). Still, they have not yet explicitly focused on prognostic risk factors in postoperative patients, nor have they distinguished and compared survival differences among patients after amputation, radical resection, and local resection.…”

Lung and bone metastases patterns in limb osteosarcoma: Surgical treatment of primary site improves overall survival

“…Kaplan–Meier (K–M) curves and log-rank tests were used to analyze the overall survival of limb OS patients with lung and/or BM, and Cox regression analyses were performed to identify the prognostic factors for lung and/or BM. [ 13 ] Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) 25.0 (IBM, Armonk, NY), all survival charts were used GraphPad Prism 9 (GraphPad, Inc.). Statistical significance was defined as a 2-tailed P < .05.…”

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

“…Pediatric limb salvage has become a standard surgical treatment method for osteosarcoma and traumatic injury. 1 Pediatric limb reconstruction is more than “replacing like with like,” as it must take into consideration the following: growth preservation in a skeletally immature patient, the reconstructed limb’s functional outcome into adulthood, multiple tissue type reconstruction, joint integrity, and need for appropriate immobilization postoperatively. This adds to the concerns that surround all pediatric reconstruction, including the patient’s emotional and social needs, donor site morbidity, and aesthetic outcome.…”