Prognosis of Primary Osteosarcoma in Elderly Patients: A Comparison between Young and Elderly Patients

Abstract

Objectives: Osteosarcoma is the most common malignant bone tumor in childhood. Although a poorer prognosis has been described in older patients, few reports have focused solely on primary osteosarcoma. We evaluated the clinical features of elderly patients with primary osteosarcoma. Materials and Methods: Ninety-four patients were included in this retrospective study, and we divided them into 2 groups (older patients and younger patients) based on a cut-off age of 40 years. The patients’ information, including age, tumor type, location, presence of metastasis, American Joint Committee on Cancer (AJCC) stage, treatment-related factors, local and distant relapse, and outcome, was collected. We compared the clinical courses between the 2 groups in all and only deceased patients. Results: In all patients, the frequency of chemotherapy in the older group was significantly lower than in the younger group (p < 0.001), and tumors were more frequent in axial bone in the older patients (p = 0.041). Only in patients with surgical treatment, histological effectiveness after chemotherapy in the older group was lower than in the younger group (p = 0.041). The older patients showed a poorer prognosis (p = 0.031). However, the 5-year overall survival rate in the older patients was more favorable than that in the younger patients only among deceased patients (p =0.032). Only the existence of metastasis affected the prognosis in older patients (p = 0.012). Conclusion: Primary osteosarcoma in elderly patients showed a high incidence of axial bone involvement, a low rate of chemotherapy, and resistance to chemotherapy. Although the final life prognosis is poor, survival may be relatively prolonged.

The Nomogram for Early Death in Patients with Bone and Soft Tissue Tumors

“…Increased negative influence of older age was also revealed in other studies. In studies evaluating the cut-off age of 40 or 50 years for osteosarcoma, older patients showed worse survival [12,13]. Besides, the tumor in trunk was more commonly found in older patients and was associated with worse survival in the previous studies and our analysis.…”

The number of osteoclasts in a biopsy specimen can predict the efficacy of neoadjuvant chemotherapy for primary osteosarcoma

“…In previous studies, good responders were observed in 0%-48% of cases > 40 years old who received neoadjuvant chemotherapy 3 . In our study, only 2 of 9 patients (22%) over 46 years old showed a good response to neoadjuvant chemotherapy, and age < 46 years old was a predictor of a good response to chemotherapy as demonstrated in previous studies 4 , 5 (Table 3 ). The chemotherapy regimen, dose, and the number of courses differed among elderly patients, mainly due to the frequency of adverse events and organ dysfunction with aging, and the efficacy of chemotherapy depended on individual patients’ characteristics 4 , 5 .…”

“…In our study, only 2 of 9 patients (22%) over 46 years old showed a good response to neoadjuvant chemotherapy, and age < 46 years old was a predictor of a good response to chemotherapy as demonstrated in previous studies 4 , 5 (Table 3 ). The chemotherapy regimen, dose, and the number of courses differed among elderly patients, mainly due to the frequency of adverse events and organ dysfunction with aging, and the efficacy of chemotherapy depended on individual patients’ characteristics 4 , 5 . However, the multivariate analysis in our study revealed that, rather than the type of drug or number of courses, the age and osteoclast number were predictors of the efficacy of neoadjuvant chemotherapy.…”

“…Osteosarcoma in elderly people shows a second incidence peak, but the prognoses are reported to be poor. One reason for such poor prognoses is due to a low sensitivity to chemotherapy, with an efficacy rate ranging from 0 to 48% 4 , 5 , and thus, surgical treatment alone is usually performed without neoadjuvant chemotherapy, due to the susceptibility of adverse events occurring in association with chemotherapy.…”

Microarray Profiling in Fibrogenesis Imperfecta Ossium

“…Similarly, the SPOP gene, known as a POZ domain gene is a regulator of skeletal development, and may lead to shorter digit bones and lower bone density 8 . SDHD has an association with abnormality of limb bone (HP:0040068 (HPO_PHENOTYPE_GENE)), SAP30BP 9 , and EIF2S2, EIF4G1,and EIF4A2 all belong to a eukaryotic translation initiation factor gene family that are known to have role in apoptosis in osteosarcoma cells. Osteosarcoma is a type of cancer that produces immature and weak bones 10 .…”