Increased survival, limb preservation, and prognostic factors for osteosarcoma

Abstract

Preoperative intraarterial (IA) cisplatin (CDP) was administered to 92 patients with nonmetastatic osteosarcoma. The ages of the patients ranged from 4 to 28 years. Sixty-four patients (70%) received 2 or 3 preoperative courses and 28 (30%) received 4 or more. Sixty-two specimens were available for pathologic examination to assess the degree of tumor necrosis. More than 90% tumor destruction was observed in 16 of 42 patients (38%) who received 1 to 3 preoperative courses as opposed to 17 of 20 (85%) who received 4 or more courses. Patients who received 4 or more courses had a 2-fold probability of achieving more than 90% tumor necrosis, and 68% underwent conservative surgery. Of those who received 3 or less courses, 23% underwent conservative surgery. Postoperatively, patients were treated with intravenous (IV) CDP alternating with doxorubicin (ADR) (Adriamycin, Adria Laboratories, Columbus, OH). Pulmonary metastases developed in 36 patients, bone metastases in 2, and local recurrence in 6. Two patients died of cardiac failure without evidence of disease. Thus, 46 patients (50%) were continuously free of disease 18 to 78 months after diagnosis. Univariate and multivariate analyses showed that male sex, low grade preoperative chemotherapy-induced necrosis, and nonosteoblastic histologic condition were prognostic factors predictive of recurrence, while male sex and large tumor size were prognostic factors predictive of death. These results are comparable with those reported by other centers and are superior to our previous experiences that yielded survival rates of 5% to 10%. A substantial number of patients also had the opportunity to achieve tumor removal with conservative surgery.

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

“…Today, the five-year disease-free survival rate has reached 60-70%, using the most recent chemotherapy protocols (8)(9)(10)(11)(12) . Poor histological response to preoperative chemotherapy, as assessed by the degree of necrosis in the surgical specimen, is also considered to be one of the most important unfavorable prognostic factors relating to the survival of osteosarcoma patients (6,7,8,(13)(14)(15)(16)(17)(18)(19)(20)(21) . In the literature, the grading method that is still most used is the one described by Huvos et al (22) , in 1977.…”

“…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.…”

“…There seems to be almost a consensus in the literature (7,8,12,13,(17)(18)(19) that the degree of tumor necrosis induced by preoperative chemotherapy is an important prognostic factor in relation to the survival of patients with primary osteosarcoma. This has also been seen in Brazilian studies (6,15,21,24,25) . Patients whose resected surgical specimens present tumor necrosis greater than 90% (Huvos types III and IV) have a better prognosis than shown by those whose specimens present tumor necrosis of less than 90% (Huvos Comparing the degrees of tumor necrosis (Huvos I versus Huvos II), they did not reach statistically significant levels and were not considered to be prognostic factors for MFS (Figure 3).…”

Microarray analysis identifies distinct gene expression profiles associated with histological subtype in human osteosarcoma

“…The prognostic relevance of histological subtypes of osteosarcoma has received little attention and remains a controversial issue [3][4][5][6]. Previous studies have shown that the histological subtype of osteosarcoma is a predictive factor for response to chemotherapy [7,8] and correlates with disease-free [9,10] and overall survival [3].…”

Measurement of total and local bone morphogenetic protein concentration in bone tumours

“…BMPs have been shown to contribute to abnormal bone formation and its occurrence in malignant tissues can be used to determine prognosis [13,33,34], in addition to other factors such as sex [5,16,18], its site [2,5,6], its size [2,5,16], the duration of symptoms and histological subtype [5,16,17]. Yoshikawa et al detected BMP in only some samples of osteosarcoma; their patients with BMP-producing osteosarcoma had lung metastases more often than those with osteosarcoma which did not produce BMP [33,34].…”