Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

Abstract

Context.-In osteosarcoma treated with neoadjuvant chemotherapy the extent of tumor necrosis on resection is considered an indicator of treatment response, and this has been shown to correlate with survival in most but not all studies.Objective.-To identify additional histologic variables of prognostic significance in high-grade osteosarcoma.Design.-Slides of pretreatment biopsy and primary postneoadjuvant chemotherapy resections from 165 patients with high-grade osteosarcoma were reviewed. Univariate (Kaplan-Meier) and multivariate (Cox regression) analyses were performed to identify clinical and histomorphologic attributes associated with overall survival.Results.-Univariate analyses confirmed the prognostic significance of metastatic status on presentation, primary tumor size, anatomic site, and histologic subtype. Additionally, the identification of lymphovascular invasion, 10% or more residual viable tumor, and 10 or more mitoses per 10 high-powered fields assessed in posttreatment resections were associated with poor survival, retaining significance in multivariate analyses. Based on results from multivariate analysis, we developed a prognostic index incorporating primary tumor size and site, and significant histologic features assessed on resection (ie, lymphovascular invasion status, mitotic rate, and extent of viable tumor). This scoring system segregates patients into 3 risk categories with significant differences in overall survival and retained significance in an independent validation set of 42 cases.Conclusions.-The integration of clinical and microscopic features improves prognostication of patients with osteosarcoma.

Drug Repurposing of β-blocker Propranolol in Osteosarcoma: Preclinical Antitumor Efficacy Alone or in Combination with Chemotherapy.

“…Given that high mitotic counts are associated to OSA aggressiveness and poor prognosis [39] (Fig. 5a and b).…”

“…After histological assessment of OSA tumors, we observed a signi cant increase in combined treatment-associated necrosis as well as a profound reduction in mitotic indices. These ndings bear high translational relevance given that necrosis rate in response to therapy and mitotic index determination are two histopathological parameters routinely used in the clinical management of OSA, linked to disease aggressiveness and prognosis [33,39]. Besides complementing chemotherapy, β-blockade using PPN could also show bene t during resection of primary or secondary OSA tumors in order to antagonize several deleterious mechanisms triggered by surgery, including in ammation and release of catecholamines, activation of proangiogenic and protumoral signaling pathways, tumor cell shedding, among others [46].…”

CORR Insights®: Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas?

“…Tumors considered especially ''implantable'' such as chondrosarcoma [5,7] might provide an indication for biopsy tract removal. In addition, sarcomas treated with preoperative chemotherapy or radiation are less likely to have viable tumor cells in the tumor itself or biopsy tract [4,8]. Therefore, those patients who are not treated with preoperative radiation or chemotherapy might be better candidates for biopsy tract resection.…”

<p>CONUT Score or/and Peripheral Blood CD4+/CD8+ Ratio-Based Web Dynamic Nomograms to Predict the Individualized Survival of Patients with Advanced Osteosarcoma</p>

“…Clinicopathologic features, inflammatory indices, nutritional indices, immune indices, and metabolic indices were the most commonly used and conventionally established prognostic indicators. [5][6][7][8][9][10] In contrast, some differentially expressed and tissue-specific proteins, micro-RNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) can also serve as reliable prognosticators in various neoplasms. [11][12][13][14] It is undoubtedly that all these predictors inherently and ineluctably harbor their merits and drawbacks.…”