Postoperative Infection and Survival in Osteosarcoma Patients

Lee, Jun Ah; Kim, Min Suk; Kim, Dong Ho; Lim, Jung Sub; Park, Kyung Duk; Cho, Wan Hyeong; Song, Won Seok; Lee, Soo Yong; Jeon, Dae‐Geun

doi:10.1245/s10434-008-0184-8

Cited by 31 publications

(47 citation statements)

References 23 publications

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“…A study of 412 patients with osteosarcoma has shown that the ten-year survival of 85% for patients with infection was significantly better compared to 62% in the non-infected group [10]. Controversially, this data could not be confirmed by another report on 31 infected patients out of a total cohort of 347 after matched control group analysis and the authors attributed positive effects of infection on survival to clinical characteristics of infected patients rather than to an anti-tumour effect of infection itself [11]. Our study did not find a significant impact of infection on survival (see Fig.…”

Section: Discussionmentioning

confidence: 92%

“…Significance between survival functions was identified by the log-rank test. According to previous reports investigating the prognostic value of post-operative infection on survival [10,11], landmark analysis was performed additionally in order to better control confounding factors. For this, a landmark was defined at 12 months postoperatively and patients dying from metastases before this landmark as well as patients developing infection after this landmark were excluded before survival analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In osteosarcoma, definition of such factors, both on a clinical and molecular basis, remains controversial due to the rarity of the disease, and there is an ongoing search for further, easily available markers predicting survival. In this context, even postoperative infection in patients undergoing surgery for osteosarcoma has been raised as a potential predictor of survival [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma

Funovics

Edelhauser

Funovics

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to investigate (a) whether pre-operative serum CRP is a predictor of survival in patients with high-grade osteosarcoma, (b) whether postoperative infection is a predictor of survival in these patients and (c) whether CRP is a predictor of postoperative infection, and especially deep prosthetic infection. Methods In this retrospective single-centre study, preoperative serum CRP levels in 79 patients (37 females, 42 males; average age, 18 years; mean follow-up, 46 months) undergoing resection of an osteosarcoma were correlated with clinical data and survival. Results The mean pre-operative serum CRP level of all 79 patients was 0.53 mg/dl (SD, 1.27 mg/dl). Patients dying of their underlying disease had significantly higher CRP levels compared to patients surviving throughout the follow-up period (1.09 mg/dl ± 2.02 mg/dl versus 0.32 mg/dl ± 0.75 mg/dl, respectively; p=0.015). CRP levels were significantly correlated with survival (Pearson's correlation coefficient= −0.25; p =0.026) and histological subtype (Pearson's correlation coefficient=−0.42; p<0.001), but not with sex, age, histological response, tumour size or metastatic disease. In uni-and multivariate survival analysis, age, response to chemotherapy and serum CRP were associated with disease-specific survival. Patients with a CRP level over 1 mg/dl had a significantly lower diseasespecific five-year survival of 36.7% compared to 73.8% in patients with normal CRP values (p=0.020). Infection was not correlated with disease-specific survival. Pre-operative serum CRP levels were not correlated with post-operative infection or deep prosthetic infection. Conclusions Pre-operative serum CRP seems to be an independent predictor of survival in patients with highgrade osteosarcoma. Further studies are needed to confirm these results on a large-scale basis.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma

Funovics

Edelhauser

Funovics

et al. 2011

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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“…There are several historical and recent reports suggesting a link between improved survival and local infection in patients treated with surgery for sarcomas [23]. However, there have also been several more recent reports of retrospective data refuting this claim and it appears that conclusive data is still lacking on this question [24]. The possibility that a local infection may incite an immune response that in turn suppresses tumor cell activity is an enticing prospect.…”

Section: Discussionmentioning

confidence: 99%

Long-term Survival of Large Cell Neuroendocrine Lung Carcinoma with Bony Metastases: A Case of Immunoprotectivity?

Paul¹,

Lander²

2016

J Orthop Oncol

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Large cell neuroendocrine carcinoma (LCNEC) is a rare, highly malignant neoplasm with a dismal prognosis. The majority of patients will present with metastatic disease with a median overall survival of 6 months for this group. We present a case of metastatic LCNEC to the pelvis with a 10 year survival after tumor resection, radiation, and chemotherapy. We hypothesize that his survival and cancer stability are the result of an immune response brought on by a sub-acute turned chronic wound infection. After adjuvant therapies, he remained disease-free for 4 years until a recurrence in his lung and new metastases to his spine, which were treated with radiation. He remained disease-free for an additional 6 years, during which time, he discovered to have a chronic infection of his right femur with Staphylococcus lugdunensis. To the best of our knowledge, this is the first long-term survivor of LCNEC with bony metastases. Keywords: Case ReportThe patient, a fifty-five year old male, initially presented in 2003 with complaints of several months of worsening activity-related right hip pain that improved with rest. Initial plain radiographs of the hip and pelvis were read as negative and the patient was treated for presumed muscle strain. When symptoms persistently worsened, the patient presented to the emergency department in March of 2003 and was noted at that time to have an abnormality on plain film and CT scan. The patient's social history was remarkable for 50-100 pack per year smoking history, 2 drinks of alcohol daily, and employment as a life-long laborer. The patient had no significant family history of cancer but a significant family history of coronary artery disease and diabetes.Plain radiographs of the pelvis obtained in the emergency department revealed a destructive lytic lesion involving the right hemiplevis and acetabulum. Further work-up included serum laboratory tests, a bone scan, and chest, abdomen and pelvis CT. An elevated serum alkaline phosphatase at 149 U/L was the only significantly abnormal serum laboratory value. The bone scan revealed sites of abnormal uptake at the 5 th rib, left scapula, right sacrum, left proximal femur and the right hemipelvis, which were read as concerning for metastatic disease. The CT scan revealed a 2.5 cm by 1.5 cm lung mass. His ECOG score was determined to 2 due to decreased mobility from right hip pain.In April of 2003, the patient underwent a non-diagnostic needle biopsy of the lung mass. An image-guided needle biopsy of the pelvis was then performed. Findings revealed adenocarcinoma with immunostaining positive for cytokeratin-7, negative for cytokeratin-20 and positive for TTF-1 and were deemed consistent with metastatic non-small cell lung cancer. In May of 2003, the patient was taking to the operating room for surgical stabilization and treatment of the pelvic lesion, which included a modified Harrington pelvic and acetabular reconstruction (Figure 1). The patient received 10 liters of crystalloid and had an estimated blood loss of 4500 milliliters ...

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“…58 Interestingly there are reports, which suggest increased survival in patients with osteosarcoma and developing periprosthetic infection after reconstructive surgery, suggesting a potential immunologic antineoplastic advantage induced by infection. 57,59 Treatment is similar to treatment of infected total knee or hip prosthesis, except there is a dramatically larger dead or infected tissue, and immune deficiency due to oncologic treatments, requiring more aggressive treatment. 60 Deep infections in patients with megaprostheses require treatment by surgical methods because the long-term administration of antibiotics alone is not sufficient.…”

Section: Custom-made Megaprosthesismentioning

confidence: 99%